The word Lupus is a Latin word meaning “wolf” and this word was coined because the rash in a patient with Lupus resembles the bite of the wolf! Lupus is a Chronic Auto-Immune Disease where the body’s autoimmune system instead of serving its normal protective function, forms antibodies which start attacking healthy tissues and causes inflammation.
In an interview with HT Lifestyle, Dr Kaushik Bhojani, Head of Rheumatology Services at Fortis Hospitals in Mumbai, explained, “Normally these antibodies are meant to fight outside infections such as bacteria and viruses. However, in Lupus, the body loses its ability to differentiate between these foreign invaders (antigens) and our normal healthy tissues. Hence the body’s own immune system begins to fight against its own “self”. The antibodies then combine with the self-antigens and forms immune complexes within tissues which cause inflammation within the organs. This can sometimes cause major health issues and can even be life threatening!”
He added, “Quite often, in our country, this disease is diagnosed late because the patient reaches the Rheumatologist late. By this time, the inflammation has spread to involve multiple organs and then the disease becomes life threatening. Young lives have often been lost by the time this disease is diagnosed.”
CAUSES:
According to Dr Kaushik Bhojani, the causes of Lupus are many and sometimes quite obscure where Lupus occurs in a genetically susceptible person who is exposed to a trigger and some well-known triggers are:
- Sunlight and ultraviolet exposure
- Bacterial or viral infections
- Hormonal treatments containing Estrogens can trigger a flare
- Some drugs can also trigger a flare
- In diagnosed cases, overexertion, stress, emotional upheaval is known to cause flares
- Pregnancy can trigger a flare of lupus hence, patients having Lupus must plan their pregnancy only when the disease is well controlled and consult their Rheumatologist who will do a detailed workup before the couple plans their pregnancy
However, most often, one is not able to identify a cause for the trigger.
SYMPTOMS:
A key symptom, as per Dr Kaushik Bhojani, is a skin rash involving the face, particularly the cheeks bones – known as ‘Malar Rash’. This is usually in the shape of butterfly wings and hence is also called a ‘butterfly rash’. Other symptoms include:
- Sun sensitivity
- Painful swollen joints
- Frequent mouth ulcers
- Excessive hair loss
- Persistent Anemia
- Prolonged fever and no clear evidence of infection anywhere
- Fingers turning white or bluish on exposure to cold
- Excessive fatigue
- Kidney infection in the young without apparent cause – such as swelling in legs, frothy urine
- Chest pain and breathlessness on exertion
When there is a combination of more than one symptom present, it is easier to suspect this illness.
SEEK HELP:
Dr Kaushik Bhojani highlighted, “Usually, it is common for a patient to consult his or her family physician in case of fever, generalised body ache etc and if the onset of illness is with joint pains, usually a patient first consults a nearby Orthopedic surgeon. However, if the patient has a ‘Plus Syndrome’, meaning that there are symptoms affecting different aspects of the patient’s body, then the patient must not lose time. If the patient has joint pains and hair loss or the patient has a low-grade fever and joint pains or for that matter a skin rash along with hair loss and joint pains, then it is important to realise that this is not an ordinary illness and needs a specialist consult.
TREATMENT:
Dr Kaushik Bhojani suggested that the management of Lupus involves three major aspects:
a) Arriving at the diagnosis correctly and quickly. Some autoimmune disease can look similar and a correct diagnosis is essential. A detailed history, with a thorough clinical evaluation, is non-negotiable. This is followed by laboratory tests to confirm the diagnosis. The tests range from routine haematology tests upto Immunological tests like an Antinuclear Antibody test (ANA). This ANA is followed by in depth Immunological testing along with tests for internal organ affection basis clinical signs.
b) Assessing the degree of involvement: A detailed clinical evaluation from head to toe is important because lupus can involve one or many organs. The treatment will depend on the extent of the Lupus and the intensity of organ inflammation.
c) Monitoring of disease control: At each visit, answering a detailed questionnaire, evaluation, along with lab testing for assessing internal organ function, is required to keep this disease well under control.
Basis the above three parameters, the treatment and intensity of treatment is to be determined. However, it is very important to remember that there is no permanent cure for Lupus, and treatment will need to be continued indefinitely even after the patient feels that he/she is well.
PREVENTION:
Dr Kaushik Bhojani recommended the following preventive measures:
a) The patient must avoid going out in the sun between 9.00AM to 5.30PM
b) If unavoidable, then covering up well using long sleeved dresses, using caps and sunglasses are essential. In addition, use of sunscreens with a high SPF of greater than 40 is essential
c) Avoid going for picnics to beaches or riverside because the sun rays reflected from the water are even more dangerous triggers. Going swimming in the sunlight is simply out of the question
d) Avoidance of hormonal pills containing Estrogens is necessary, Hence even for contraception, only Progesterone pills are safer.
e) When consulting other doctors, they must be informed hand that you have Lupus and you must contact your rheumatologist to ensure that there is no risk with the treatment prescribed by them
f) Before undergoing any planned surgery, you must consult your rheumatologist and preferably have your surgeon talk to your Rheumatologist
g) Importantly, pregnancy planning must be avoided in active disease.
