SYSTEMIC LUPUS
What is systemic lupus?
Systemic lupus is an autoimmune disease that occurs when the immune system attacks the body, affecting the skin, joints, and potentially a number of organs. Although the cause is not known, it can be triggered by environmental factors, such as stress, trauma, viruses, some medications, and ultraviolet rays.
Lupus is a connective tissue disorder. Other connective tissue disorders include Sjogren’s Syndrome, scerloderma, and mixed connective tissue disease.
Lupus is often inherited, but the genetics are complex so it does not always run in families.
The condition is nine times more common in women than men, and symptoms may become more severe during menstruation and pregnancy.
The condition can be very difficult to diagnose as its symptoms are often the same as other conditions. Every patient is different, and symptoms vary greatly from case to case, sometimes occurring suddenly, other times developing slowly over time. In most cases, the symptoms occur in episodes known as flares, during which the symptoms worsen for a period of time before improving or even disappearing completely for a while.
What are the symptoms?
Although symptoms vary from case to case, some common symptoms of the condition include fatigue; joint pain and swelling; hair loss; and skin rashes. A lupus rash is most often photosensitive (gets worse in the sun). The classic lupus rash is the “butterfly” or malar rash which occurs over the bridge of the nose and cheeks, but lupus rashes can be varied and often need a dermatologist to correctly diagnose.
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How is it diagnosed?
In order to diagnose the condition, a thorough physical examination will be performed. At this point, symptoms like sun-sensitive rashes, ulcers in the mouth, arthritis, hair loss, and signs of systemic involvement will be looked for. A dipsticks test on the urine will also be important as it can be the earliest sign of lupus involvement in the kidney.
Additional tests may include antibody tests, a complete blood count, a chest x-ray, and further urinalysis.
The antibody tests for lupus are not specific (i.e. if they are positive they do not necessarily mean the person has lupus or a connective tissue disease) and must therefore always be interpreted in conjunction with the patient’s symptoms and examination findings.
How can it be treated?
The treatment for lupus will depend on whether there is organ (kidney, lung, brain) involvement or not.
If there is only skin and joint involvement, patients can usually be well controlled on topical treatments for the skin and Chloroquine / Plasmaquine, (known as anti-malarials), for the other symptoms. Anti-malarial medications have been shown to improve muscle and joint pain, skin rashes, pericarditis (inflammation of the lining of the heart), pleuritis (inflammation of the lining of the lung), and other lupus symptoms such as fatigue and fever. These medications may also prevent lupus from spreading to certain organs, such as the kidney and central nervous system (the brain and spinal cord) and may help to reduce flares by as much as 50%. Chloroquine / Plasmaquine are the key to controlling lupus long term, and some lupus patients may be on this for the rest of their lives.
Anti-malarials are usually well tolerated but do need careful monitoring by an ophthalmologist in those on long term treatment.
Anti-inflammatories may be needed for joint symptoms and low dose Prednisone is sometimes needed to treat inflammation.
If there is major organ involvement, patients may need stronger immune-suppressive medication. In these situations, there is usually a multi-disciplinary team of specialists looking after the patient.
Most patients with lupus have mild disease which is well-controlled in the long term.
However, lupus is an unpredictable auto-immune disease and hence must be regularly monitored.
Pregnancy in lupus is possible if the disease is well-controlled and if your doctors advise that it would be safe to fall pregnant. In this case, regular checks in pregnancy are essential.
As with all auto-immune diseases, diet and lifestyle lay an important part in managing the condition.
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