Many counties in the world use the month of May to increase public awareness of lupus, a common chronic autoimmune disease, that is more pervasive and more severe than many people think, and has an impact that the public does not realize. At this time there is no cure for lupus but treatments can help control symptoms.
What is lupus?
Lupus is a chronic inflammatory disease that occurs when the body’s immune system attacks its own tissues and organs. Inflammation caused by lupus can affect many different body systems — including joints, skin, kidneys, blood cells, brain, heart and lungs. Lupus is not an infectious disease. It is not contagious, so you cannot get it by coming into contact with a person who has it.
Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus. There are many kinds of lupus. The most common and severe type is systemic lupus erythematosus (SLE) which affects many internal organs in the body.
Some people are born with a tendency toward developing lupus which may be triggered by infections, certain drugs or even sunlight.
What causes lupus?
We are still not completely sure what causes lupus.
Many experts agree that lupus occurs when your immune system attacks healthy tissue in your body. It is likely that lupus results from a combination of your genetics and your environment. It appears that people with an inherited predisposition for lupus may develop the disease when they come into contact with something in the environment that can trigger lupus. Some potential triggers for lupus include:
• Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people.
• Infections. Having an infection can initiate lupus or cause a relapse in some people.
• Medications. Lupus can be triggered by certain types of anti-seizure medications, blood pressure medications and antibiotics. People who have drug-induced lupus usually see their symptoms go away when they stop taking the medication.
How do you know if you have lupus?
No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus have mild disease characterized by episodes — called flares — when signs and symptoms get worse for a while, then improve or even disappear completely for a time.
The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. The most common signs and symptoms include:
• Fatigue and fever
• Joint pain, stiffness and swelling
• Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose
• Skin lesions that appear or worsen with sun exposure (photosensitivity)
• Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud’s phenomenon)
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches, confusion and memory loss
How is lupus diagnosed?
Diagnosing lupus can be challenging even for experienced doctors. Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders. No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings lead to the diagnosis. Lupus can be deadly. If you think you may have lupus, see a doctor right away. Treatment is much more successful if begun early and followed faithfully.
Complications
Inflammation caused by lupus can affect many areas of the body, including the kidneys, brain, blood vessels, lungs, and heart. Your doctor will be ble to describe in detail these complications.
Complications relating to pregnancy
Women with lupus have an increased risk of miscarriage. Lupus increases the risk of high blood pressure during pregnancy (preeclampsia) and preterm birth. To reduce the risk of these complications, doctors often recommend delaying pregnancy until your disease has been under control for at least six months.
Treatment
Treatment will depend on a number of factors, including your signs and symptoms. Determining whether your signs and symptoms should be treated, and what medications to use, requires a careful discussion of the benefits and risks with your doctor. As your signs and symptoms flare and subside, you and your doctor may find that you will need to change medications or dosages. The medications most commonly used to control lupus include:
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), may be used to treat pain, swelling and fever associated with lupus.
• Antimalarial drugs. Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), can also help control lupus.
• Corticosteroids. Prednisone and other types of corticosteroids can counter the inflammation of lupus but often produce long-term side effects. The risk of side effects increases with higher doses and longer term therapy.
• Immunosuppressants. Drugs that suppress the immune system may be helpful in serious cases of lupus. Examples include azathioprine (Imuran, Azasan), mycophenolate (CellCept), leflunomide (Arava) and methotrexate (Trexall). A newer medication, belimumab (Benlysta), also reduces lupus symptoms in some people.
All these medications have side effects and these must be taken into consideration when using these medications.
Lupus is a chronic disease and individuals with this condition must learn to live with it and take any measures that can help prevent lupus flares.
Individuals with lupus are encouraged to have regular check-ups with their doctor instead of only seeing your doctor when your symptoms worsen. This may help your doctor prevent flare-ups, and can be useful in addressing routine health concerns such as stress, diet and exercise that can be helpful in preventing lupus complications.
All individuals should get adequate rest to help relieve the fatigue that is common in lupus. Individuals with lupus should be careful with too much sun exposure. Ultraviolet light can trigger a flare. Wear protective clothing — such as a hat, long-sleeved shirt and long pants — and use sunscreens with a sun protection factor (SPF) when outdoors.
Individuals should also do the following:
• Get regular exercise. Exercise can help you recover from a flare, reduce your risk of heart attack, help fight depression and promote general well-being.
• Do not smoke. Smoking increases your risk of cardiovascular disease and can worsen the effects of lupus on your heart and blood vessels.
• Eat a healthy diet. A healthy diet emphasizes fruits, vegetables and whole grains. Sometimes you may have dietary restrictions especially if you have high blood pressure, kidney damage or gastrointestinal problems.
Conclusion
Lupus can be a challenging condition for those affected and for clinicians managing this autoimmune disorder. Sometimes there are long delays in making the diagnosis, and for many the side effects of medications can be very severe. Fortunately, newer mediations ae making controlling of signs and symptoms easier and many patients can have very few flares for many years.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
