Today we are going to talk about a Disease called “SLE” or “Systemic Lupus Erythematosus” or simply called “Lupus”. Lupus is basically an autoimmune disease.
When we say
autoimmune disease, it means that our immunity is attacking our own body. Normally,
immunity is our resistance power. It's a power to fight against any infections that
are affecting our own body, and it is usually protective for one's body. But
certain times, this immunity can attack their own self, and that is when we
call it autoimmunity.
Lupus is one
of the most important autoimmune diseases, which commonly affects women between
15-40 years of age. So very young women can get affected with this disease. Males
are rarely affected in this particular condition. But no age is an exception. There
could be very young children who can get the disease, they could be elderly people
also who may develop this disease.
Symptoms
As I said, since this is an autoimmune disease, it can affect different parts of the body. Most of the times, 90% of the time, the disease affects your skin, joints, or the blood counts. So most of them present to us with skin rashes, especially over the cheeks and the nasal bridge. On exposure to the sun, rashes can occur on any part of the body. Along with that, heavy hair loss, ulcers in the mouth, ulcers in the nose are other common symptoms.
Another set
of people can start off with joint pains and joint swellings, with a lot of stiffness
in the early morning when they will not be able to make a fist. And certain
people may present with decrease in blood count, which can start of all of a sudden
and does not respond to common medications like iron tablets or vitamin
supplements. So here, what happens is that hemoglobin may drop, the WBC count
(platelet count) might just drop and despite giving blood transfusions or
platelet transfusions, the counts may not actually improve because though we are
supplying them outside blood and blood products, symptom.
Diagnosis
Most of the times, patients with lupus do not reach a rheumatologist initially. They have symptoms, but it pertains to any particular organ. For example, they initially have only a skin brash. Then they may meet a dermatologist. Or if they have chest pain, or if they are experiencing breathlessness, they might meet a cardiologist. The immunity will keep damaging their blood cells. This is the most common presentation, but along with this, the people can present with kidney problems. About 50% of them are susceptible to protein loss through the kidney. It doesn't necessarily imply that their kidney is broken. Simply put, it indicates that more protein is leaving their kidney. It is feasible to fully regulate this disease and restore the kidney to its fully normal stage if we identify that they have a kidney issue at an early stage. 30% of them can have problems in the muscles, can have problem with their heart, or the lungs. Therefore, they may manifest with chest pain, dyspnea, or pain on one side of the chest or in the middle of the chest, as well as intermittent or constant shortness of breath. Their intestine may be giving them trouble. They may experience issues with their brain or nerves.
Basically,
no organ is spared by lupus. Any organ can be affected, and you might
experience a new symptom for the first time. Basically, this specialist, this
doctor, is the one who might actually see you, keep all of your symptoms
together, examine your reports, and then might label you as a patient with
lupus and refer you to a rheumatologist.
A
rheumatologist's job in lupus is to first confirm that it is lupus by asking
you about your symptoms, reviewing your blood work, and performing particular
tests that are extremely specific to lupus, such the ANA. Based on this, we
determine that you have lupus, and after we determine this, we examine the
organs that are being affected because, despite the fact that you may only be
experiencing joint pain, you could actually have kidney involvement, which may
not be obvious to you but may be on the test that we perform. So we do some
tests to find out which other organ is involved. After we find out which organs
are involved in lupus, accordingly the treatment will change.
Treatment
In lupus, we will have to give steroids in the initial phases at higher doses. Steroids typically aren't excellent for the health of the average male because they really lower immunity. However, in lupus, immunity affects one's own body; this immunity is what is wrong, so we must control it. For this reason, steroids are crucial in the initial stages of lupus treatment.
We don't
want to keep using really high steroid doses in the long run. We would have
used very low amounts of the steroid, which won't likely hurt you. In essence,
we'll continue to use a very low steroid dose. However, we add a substance
known as a steroid sparing agent, which has the same effects as steroids,
because we do not want the condition to worsen as we reduce the steroid. They
don't typically have the negative side effects as steroids do.
These
steroid-sparing treatments for lupus are particularly beneficial for both
long-term disease control and patient survival. Typically, lupus patients can have
a moderate condition where their skin or joints are just impacted, a mild drop
in blood count, or even a serious disease where their kidneys and nerves are
being harmed.
The specific
person's treatment may vary depending on the disease's severity. There may be
individuals who get only very modest amounts of steroids, extremely high doses
of steroids, steroid sparing medications, minor immunosuppressants, or severe
immunodepressants. The type of treatment varies on the disease's stage.
The disease
would initially be at a phase when it could be treated for those who refuse
therapy. The kidney can recover to normal function if we begin treating any
kidney illness in its early stages. However, if we don't do it, the kidney risk
long-term damage. They might represent a rise in creatinine. You could need to
start receiving dialysis or get a kidney transplant.
Having lupus
is a serious illness. Even in those who receive their medication on a regular
basis, there may still be many difficulties. There may be flare-ups in specific
circumstances, such as when your medication doses are abruptly reduced, you
temporarily stop taking it, or you are dealing with a stressful situation. In
these situations, the disease may suddenly worsen and control and resolution of
the condition may become very challenging. Only 90 out of every 100 lupus
patients would survive after five years, according to known statistics.
Numerous
studies are being conducted to determine whether even these 10 individuals lead
typical lives. But that's the way the illness is right now, at this point. Basically,
all we ask of the patient is regular follow-up, regular monitoring, recommended
treatment, and constant communication with us about any new symptoms they have.
We might
invite you to come in for follow-up visits every month or every two months in
the first few years. Once the disease is fully under control and we have
control over the situation, we will call you every three to six months and
adjust the medicine as necessary. Some lupus patients who have their condition
under control may only need to take one or two drugs in the future.
Precautions
The patient
is expected to take the following safety measures: First, it has been
discovered that UV rays worsen lupus. They can make the condition worse by
raising the body's production of ANA. Lupus patients typically comply with our
expectations by avoiding sunlight exposure from 10 am to 4 pm. Even if kids
must be exposed for a variety of reasons, it is preferable that they use
sunscreen, hats, or umbrellas to prevent direct sun exposure.
Second, we
want people to lead highly healthy lifestyles, which include exercising for 30
minutes every day, eating a lot of fruits and vegetables, drinking a lot of
milk, and limiting their intake of junk food and fatty foods.
Another
thing we demand of our patients is that they take every precaution to avoid
being sick.
The
importance of maintaining good personal and domestic hygiene cannot be
overstated. Additionally, you should avoid crowded areas where infections are
more likely to spread because your immunity is already compromised and because
immunosuppressants are also commonly prescribed for lupus patients, which can
further impair their immunity. As a result, infections are a very common
complication for patients with lupus.
Conclusion
Lupus is a
such a vast disease with so many manifestations, if you have lupus, you should
be meeting a rheumatologist to find out which organs are affected, how serveries
your lupus, and the treatment needs to be adjusted by them accordingly.
Patients who
have a suspicion or have a doubt of having lupus, or who have already been diagnosed
with lupus and want to know more about their disease, or want to know how severe
their disease is and how their medication needs to be adjusted, or what medications
need to be taken, who need counselling for both them or their family members.
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