Systemic Lupus Erythematosus (SLE), commonly known as lupus, is an autoimmune disorder where the immune system mistakenly attacks the body's own tissues. Instead of protecting against infections and foreign invaders, the immune system targets healthy organs and systems, leading to inflammation and damage. Lupus can affect various parts of the body including the joints, skin, kidneys, liver, blood cells, brain, and gastrointestinal tract. The exact cause remains unclear but is believed to be a combination of genetic predisposition and environmental triggers that disrupt the immune system.
Symptoms
Lupus is often referred to as the "disease of 1000 faces" due to its diverse range of symptoms, which can vary greatly from person to person. Symptoms may range from mild to severe and can affect multiple body systems:
Joint pain and stiffness: Many individuals with lupus experience pain, swelling, and stiffness in the joints, particularly in the small joints of the hands and feet. This can be persistent and impact daily activities.
Fatigue and general malaise: Persistent fatigue, along with low-grade fevers and loss of appetite, is common. Weight loss may also occur as a result of the ongoing inflammation.
Skin rashes: A hallmark of lupus is a facial rash often described as a "butterfly rash" across the cheeks and nose. Rashes may also appear in other areas like the shawl region of the back and arms, and on finger pulps and nail bases. These rashes are frequently exacerbated by sunlight.
Hair loss: Many people with lupus experience hair thinning or loss, which can be distressing and affect self-esteem.
Oral and nasal sores: Painful sores or ulcers may develop in the mouth or nose.
Cold-related symptoms: Fingers and toes may become painful and change color in response to cold, a condition known as Raynaud’s phenomenon.
Kidney issues: Lupus can lead to kidney inflammation, or lupus nephritis, which is a serious complication that can affect kidney function.
Respiratory and cardiovascular Issues: Difficulty breathing and chest pain may occur, often due to inflammation of the lining of the lungs or heart.
Neurological symptoms: Seizures and other neurological symptoms can arise, affecting the brain and nervous system.
Blood clots and reproductive issues: Increased risk of blood clots and recurrent miscarriages are also seen in some individuals with lupus.
Risk factors
Lupus predominantly affects women, with a ratio of approximately 9:1 compared to men. The disease often manifests during hormonal changes such as puberty, childbirth, or menopause. It is also more common in women of Asian and African descent compared to Caucasians. Lupus typically presents in individuals between the ages of 15 and 44, although it can also affect children and, less frequently, people over 50. The latter cases tend to be less severe.
Impact on kidneys
Lupus nephritis, or kidney involvement in lupus, is a significant concern as approximately 60% of lupus patients may experience kidney problems. The kidneys are vital for filtering waste from the blood, and lupus can disrupt this process, leading to potential kidney failure. Early stages of kidney involvement might not present with obvious symptoms, but urine tests can reveal abnormalities such as proteinuria (excess protein in urine) and hematuria (blood in urine). In severe cases, rising blood pressure and decreased urine output can signal worsening kidney function. Regular monitoring by a rheumatologist is crucial to detect and manage kidney involvement early.
Treatment
Management of lupus depends on the severity and type of symptoms. For milder cases, treatment often involves:
Non-steroidal anti-inflammatory drugs (NSAIDs): These are used to alleviate joint pain and inflammation.
Antimalarial medications: Hydroxychloroquine, initially developed to treat malaria, can help control skin rashes and joint symptoms.
Corticosteroids: Prednisone and similar drugs reduce inflammation and suppress immune system activity. These can be administered orally, through injections, or intravenously.
For severe cases or when organ systems are involved, treatment may include:
Immunosuppressive drugs: Medications such as azathioprine, methotrexate, cyclosporine, mycophenolate mofetil, and cyclophosphamide help to suppress the overactive immune response and reduce inflammation.
Effective management of lupus requires a comprehensive approach, including regular medical check-ups, blood tests, and adherence to prescribed treatments. By addressing symptoms early and effectively, individuals with lupus can improve their quality of life and manage the disease more successfully.
(Dr Dipti Patel is Consultant Rheumatologist, Wockhardt Hospitals, Mumbai Central)
