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Lupus by Dr. Humeira Badsha

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Lupus is a disease which usually affects young women with joint pains and other symptoms. It can vary from very mild to very serious but it is always important to be under the care of a rheumatologist.

What is lupus?
Lupus or SLE (systemic lupus erythematosus) is a disease which can affect joints, muscles and other parts of the body. It is often described as an auto-immune disease. This means that for some unknown reason people with lupus seem to develop antibodies (which usually fight bacteria and viruses) that attack healthy tissues instead. This produces inflammation in different parts of the body resulting in pain and swelling. Lupus can also affect the skin, heart, lungs, nervous system, kidneys and blood and in particular the immune system. Lupus is a chronic, systemic disease. This means that it lasts a long time, probably for the rest of your life. However, nearly all people with lupus have periods of improvement (remissions). Some people have complete and long-lasting remissions.

Who gets lupus?
Lupus tends to affect women in their childbearing years. However, lupus can occur in young children or in older people. The number of women affected outnumber men by nine to one.

What causes lupus?
We don’t know the cause of lupus. Some people seem to inherit the tendency to get a disease like lupus. Research suggests that an unidentified virus may trigger the tendency and bring on the disease. A few drugs taken for conditions like high blood pressure or tuberculosis can cause symptoms just like lupus but these symptoms always disappear when the drug is stopped. Exposure to sunlight seems to trigger lupus in some people. Certain medications such as common blood pressure or heart medications can cause drug induced lupus (procainamide (Pronestyl), hydralazine (Apresoline), quinidine (Quinaglute).

The following symptoms and signs are much more suggestive of lupus:

  • A rash over the cheeks and bridge of the nose
  • Rashes after exposure to the sun or ultraviolet light
  • Ulcers inside the mouth occurring every month
  • Arthritis of two or more joints i.e, the joints hurt and are swollen
  • Pleurisy – pain in the chest on deep breathing
  • Seizure or fits/ epilepsy
  • Anemia (low blood counts)
  • Raynaud’s – fingers turning white and/or blue in the cold
  • Hair loss in large clumps
  • Swollen glands

Diagnosing Lupus
Lupus is usually easy to diagnose when an individual has many of the more characteristic symptoms and signs, but is made more difficult if only a few are present. Laboratory tests are then usually conducted to help confirm or reject the diagnosis, These tests may include a blood count and urine analysis. More specific laboratory tests look for antibodies, in particular antibodies to the nuclei of cells (the ANA or Anti-Nuclear Antibody test) and antibody to DNA. Over 99 per cent of people with lupus have a positive ANA test. However, only about 30 per cent of people with a positive ANA test have lupus.

ACR criteria for diagnosis of systemic lupus erythematosus (4 out 0f 11 required)

Criterion Definition
Malar rash Butterfly rash on face
Discoid rash Dark, scaly rash, often around hairline with scarring
Photosensitivity Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation
Oral ulcers Monthly ulcers
Arthritis tenderness, swelling, in joints
Serositis Fluid around lungs or heart
Pericarditis – documented by EKG, rub or evidence of pericardial effusion
Renal disorder Protein or blood in urine – kidney inflammation
Neurologic disorder Fits or disturbances in behavior
Hematologic disorder Low red, white blood cells or low platelets
Immunologic disorders DNA, smith, ACA, LAC antibodies
Antinuclear antibody ANA test

The diagnosis of SLE is made if four or more of the manifestations are present, either serially or simultaneously, during any interval of observations. It has been suggested that patients be classified as follows:

  • Classical SLE — many criteria
  • Definite SLE — 4 or more criteria
  • Probable SLE — 3 criteria
  • Possible SLE — 2 criteria

Treatment
Lupus is an unpredictable disease but in most cases it can be successfully treated. Once an effective treatment program has been started, it is important for the patient to keep to it faithfully and to inform the doctor of any change in symptoms so that the medications can be modified.

Ointments/Skin creams

Your doctor may prescribe a cream containing a sunscreen to protect against sun exposure. Corticosteroid containing creams are used to control skin rashes.

Pregnancy and Lupus
Pregnancy may mean special problems for the woman with lupus since the disease affects people in their child-bearing years. The majority of women have normal pregnancies, although there is an increased risk of early miscarriage. There may be worsening of symptoms after delivery. It is important for the patient and doctor to discuss and plan the best time for the patient to have a child. Often pregnant patients need to be closely monitored by the rheumatologist as well as obstetrician during pregnancy. Certain antibodies such as anti- SSA and anti-phosphlipid antibodies should be checked before or during pregnancy.

Coping with lupus
In a chronic disease like lupus, social and emotional problems are common. You may experience feelings of anger, fear and depression. It is extremely helpful to be able to talk about how you feel with someone close to you or someone who has had similar problems

This is one of a set of articles by Dr. Humeira Badsha, Specialist Rheumatologist, for patient awareness.

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