The disease named after the wolf –Lupus
By Ranali Perera
Lupus, a chronic disease condition that affects mostly women of childbearing age (15-44 years) has a higher incidence rate in the Asian population. It is relatively common in Sri Lanka as well. Lupus is a type of autoimmune disease. Autoimmune diseases are diseases that result when the body's immune system, which is the body's defence system against harmful pathogens, attacks normal healthy cells and tissues of the body.
Lupus can affect many organs. The joints, kidneys, skin, heart, brain,lungs and blood vessels are some of those affected. This disease tends to occur in flares, with lupus episodes when the person is ill, in between time periods when the person is disease-free and well. Not much is known as to what causes lupus, but it is assumed to have both genetic and environmental influences. Environmental triggers are usually UV radiation, infections, stressful situations or drugs.
Four main types fall under the disease category of lupus:
1. Systemic lupus erythrematosus (SLE):
This is the commonest type of lupus (70% of all cases), and is generally what people mean when they say 'lupus'. It involves the entire body and affects many organs, and hence given the term 'systemic'.
2. Cutaneous lupus:
This type of lupus affects mainly the skin. Cutaneous lupus can eventually progress to SLE in 10% of the patients. Discoid lupus is also a type of cutaneous lupus.
3. Drug induced lupus:
As the name suggests, this is caused by a drug. Drugs that can commonly cause lupus are hydralazine (given for high blood pressure), procainamide (given for irregular heartbeats/ arrhythmias) and isoniazid (given for tuberculosis). The symptoms disappear after a few months of discontinuation of the drug.
4. Neonatal lupus:
This is a transient condition seen rarely in a baby born to a mother suffering from SLE. The newborn may have a skin rash with or without reduced blood cell counts, heart and liver problems. These symptoms would correct with time (usually resolves by 6 months of age).
Manifestations of Lupus
The disease affects each person differently. While some may have severe symptoms, other may have only mild symptoms affecting only a few organs. Asians have a higher incidence of kidney involvement than Caucasians.
1. General symptoms:
• Extreme fatigue
• Muscle aches
• Weight changes
• Dry eyes
2. Bone and joint involvement:
• Joint pain, one of the commonest symptoms
• Lupus arthritis usually involving the small joints (such as those found in the hands). This is not the same as rheumatoid arthritis and does not cause as many deformities as that, but may have a similar presentation.
• Increased risk of bone fractures
3. Skin involvement:
• Butterfly-shaped rash across the nose and cheeks (Malar rash)
• Increased sensitivity to UV rays either coming from the sun or artificial light (Photosensitivity). This can lead to rashes or itchiness.
• Red patches with a scaly and crusty appearance which heal with scarring or pigmentation (Discoid rash). This type of rash occurs in areas exposed to the sun such as face, ears and scalp.
• Hair loss
• Ulcers in the mouth, gums or nose
• Bluish or whitish discolouration of fingers and toes when subjected to cold temperatures (Raynaud's phenomenon)
4. Kidney involvement:
• Acute or chronic kidney failure due to a condition called lupus nephritis (inflammation of the kidneys)
• This can lead to increased blood pressure
• And swelling of ankles and the region around the eyes
5. Changes seen in blood:
• Anaemia- reduced haemoglobin levels in blood, which reduces the amount of oxygen reaching the cells
• Low white blood cells and platelets (which may occur due to treatment)
• Increased risk of blood clots
6. Heart involvement:
• Chest pain on exertion (Angina)
• Inflammation of the heart muscles which can lead to heart failure
• Inflammation of the fibrous sac surrounding the heart (Pericarditis) leading to chest pain
• Inflammation of the heart valves
7. Brain involvement:
• Headaches that may mimic migraine
8. Lung involvement:
• Changes in the blood flow of the lungs (Increased bleeding within the lung and increased blood pressure)
• Chest pain when breathing deeply
• Risk of pneumonia
• Decreased lung volume and shortness of breath
9. Psychological symptoms:
• Anxiety disorders
• Personality changes
• Memory loss
10. Enlargement of the lymph nodes (usually in children or young adults)
11. Gastrointestinal involvement: Nausea and abdominal discomfort may be warning signs of a flare.
As these symptoms can occur in a wide array of conditions, one should not be too hasty to diagnose oneself as having lupus with only one or two of them. Typically lupus presents with low grade fever, joint pain and extreme fatigue.
Identifying a flare
As SLE comes in flares and remissions, it is important to know the warning signs that indicate an oncoming episode.
• Increasing tiredness
• Nausea and abdominal discomfort
The morbidity associated with this debilitating disease can be reduced with proper management. This involves proper continuation of medication as prescribed by the doctor, diet and lifestyle modification to reduce complication burden and avoidance of environmental triggering factors like sunlight.
Heart complications are the biggest reason for deaths associated with lupus. Hence, dietary modifications, proper exercise and cessation of smoking to reduce the risk of such complications are a must for anyone suffering from this condition.
At this time and era, the number of deaths due to SLE has decreased with advancements in medical care and earlier diagnosis of the condition. However, the distress this causes can only be managed with a proper support system. A support system can include family, friends, medical professionals and support groups. Relaxation techniques such as meditation may help to reduce the stress associated with this condition.
Pregnancy and lupus
Pregnancy is not contraindicated in women with mild to moderate lupus. However, the decision to become pregnant must be taken after proper counselling and planning as pregnancy in such people are considered as high-risk.
If a woman suffering from lupus wishes to get pregnant, it must be carefully planned with the help of the doctor. Ideally, she should conceive at a disease free time period (when there are no signs and symptoms of the disease). She should also stop taking medication for several months before conception as the drugs could be harmful to a growing foetus.
During the pregnancy, women may experience mild to moderate flares. Sometimes, symptoms may manifest immediately after the pregnancy. Also, the risk of getting high blood pressure, diabetes and kidney diseases during pregnancy are higher than that for normal expectant mothers.
As some of the drugs prescribed for lupus are harmful to a growing foetus, if a woman does not wish to become pregnant, she should be on birth control. The oral contraceptive pill (commonly called the 'Pill') can be prescribed as an effective birth control option to women with stable or inactive disease as it has now been shown to have no added risk of causing a flare.
Proposed crippling countrywide strike TO SAVE ECONOMY, ASSETS, NATURAL RESOURCES– D.J. RAJAKARUNA
- Harmony needed for religious freedom – Minister 1646
- CMC property taxes 1643
- Proposed tax on EPF, ETF ICEU seeks urgent meeting with Minister 1644
- Car plunges into river Two dead, three critically injured 1645
- Arson attack on schoolgirl’s house Minister promises new home 1646
- Australian gender advocate in Lanka Broderick to meet business, public leaders 1643
- Fire at Weligama textile store 1641
- Protest planned on Matale A9 Road Compensation demand for lost property 1643
- Rs 128,250,000 spent on survey Samurdhi union demands reimbursement 1642
- NEC to boost economy – President Shot in the arm for agriculture sector 1643
- Driver who killed 13 in Barcelona rampage Spanish police in manhunt 1639
- NLB, DLB back with Finance Ministry 1637
- Govt. has failed says Sampanthan Complains in letter to UNSG 1636
- New LG Draft Bill in Parliament on 24 August 1637
- Travis Sinniah appointed Navy Chief Holder of highest combat medal 1641
- Solution to ethnic issue New Constitution the only way – Mano 1637
- 18-year sentence sought for Lankan Convicted of human smuggling 1637
- SIS man on the mat Nabbed with gold at BIA 1637
- Dullas defends Wijeyadasa 1639
- Student leader Ryan remanded Surrenders to Court through lawyers 1637
- No mandate for foreign judges – Marapana 1637
- Floods, landslides cost Rs 109 B Rs 70B needed to rebuild houses – PM 1638
- China and Turkey aspiring for Greatness in the World 3259
- General Wanasinghe’s 84th birthday today 3357
- Wiggy blasts Thavarajah 3419
- Bribery and corruption pervasive malaise in Sri Lanka 1868
- Schoolboy publisher Notching up half a century in business 1642
- Spirits Nether world inhabitants visiting us 1644
- Persisting pseudo ideals 1639
- LAW OF CRIMINAL PROCEDURE 1914
- Seven countries compete 1640
- Saparamadu wins gold medal in Taiwan 1643
- Theekshana, Ranasinghe emerge champions 1641
- Doluweera and Sayuni win in chess 1644
- Singer Cup’ U-17 Division II Cricket St. Peter’s meet Galahitiyawa Central 1641
- Ronaldo nominated for FIFA player award 1641
- Halep advances 1637
- Ton-up Cook and Root give Windies hard day’s night 1637
- England power to semi finals 1637
- More Floodlights for Dambulla 1658
- Political commentary What’s next? Who’s next? 3676
- THE SHADOWS IN THE CB SCAMS 4463
- Turmeric eaten on daily basis reverses cancer Confirmed by new scientific evidence 3936
- Drivers welcome stiffer traffic fines 4688
- What the FCID have achieved since 2015 3772
- Proposed crippling countrywide strike TO SAVE ECONOMY, ASSETS, NATURAL RESOURCES– D.J. RAJAKARUNA 2588
- No taxes on EPF withdrawals– John Seneviratne 3295
- Zero support for Justice Minister within UNP – Ajith P. Perera 3338
- Recent increase in security has caused fear among Northerners – Ramanathan 2637
- Lanka should gain from OBOR - Dr. Jayasuriya 3897
- China cracks down on VPN vendors 1644
- Roaming downtime hits customers on Three in Europe 1644
- Very few girls took computing A-levels 1643
- Chatbot helps students to choose courses 1644
- Game of Thrones struck by fresh leak 1642
- Peanut allergy treatment ‘lasts up to four years’ 1642
- Anger and hatred can make us feel happy, says study 1638
- Japanese fungus spreading in UK hospitals 1638
- Plants ‘hijacked’ to make polio vaccine 1639
- Disruption is over, and Facebook won 1638
- A time of gifts Staying on 1397
- Manuka honey:The superbug killer 2230
- A time of gifts Trying to settle down 2127
- Chithral releases his latest song 1396
- Florals: A Fashion Favourite 1394
- Be a lioness not a lamb 906
- Places to visit in Kandy 1262
- Dhothalu Oya Sandaraja Forest amidst tea estates 1390
- Understanding and Interpreting their results 1859
- Two lunar eclipses in August 1730
- Undergoing an Erashtaka period ? 1717
- Aging with Venus 1673
- Gemstones empower aura 1682
- Correlation Between Social Formation and Text 3765
- The global and local in Hong Kong cinema-part 05 3671
- Commendations or Brickbats 4313
- Why we should listen to Jane Austen in the age of Tinder 4457
- Lullaby of the Ever-Returning Love universal yet coloured by culture 4461
- A story of Palestinians without Palestine 3647
- First impressions, are they important? 3652
- Oscar nominee to perform in Sri Lanka 3644
- Healing the helpless 1728
- Winging it overseas 1713
- From the hospital to the news room 1732
- India revisited 1702
- Showers of blessings 1720
- Healing from port to port 1696
- Master gamers 1717
- The flawed beauty 1705
- The second best in Asia 1708
- Young robotics engineers 1667
- A quest to fight evil 1673
- NCT Dream 1670