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.
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