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Systemic Lupus Erythematous – causes, symptoms, diagnosis and pathology

What is Lupus?

Lupus (Systemic lupus erythematosus) is a chronic, autoimmune disease that can lead to damage of various parts of the body like the skin, joints and organs. Lupus is basically a disorder of the immune system where the body starts attacking its own healthy tissues. It produces auto-antibodies which destroys healthy tissues. These auto-antibodies lead to pain, inflammation and damage in different parts of the body.

Across the globe, nearly 5 million people are affected by Lupus. Nearly 16,000 cases of Lupus are reported each year.

Lupus is not a contagious disease. It can occur in mild forms as well as severe forms. It is essential to get Lupus in whatever form treated by a doctor.

Lupus is often difficult to diagnose because its symptoms overlap with those of other diseases. It is important to see an immunologist if there is confusion regarding overlapping symptoms and diagnosis.

There is no known cause of lupus. It can be triggered by certain infection and use of certain drugs. Women are more prone to developing lupus than men.

Lupus affects many parts of the body and therefore one can present with a wide range of symptoms. The symptoms may occur together or at different points in time.

The most common symptoms of lupus include:

  • Extreme tiredness and fatigue
  • Headaches
  • Painful, swollen joints
  • Fever
  • Pain while breathing
  • Swelling on the face, hands and legs and near the eyes
  • Butterfly-shaped rash spread across the face
  • Hair loss
  • Skin dryness
  • Mouth ulcers
  • Anemia

As you can notice, many of the symptoms mimic other disorders like chronic anemia, arthritis, fibromyalgia and other joint, muscle and bone diseases. When it doubt, the physician must always refer the case to an immunologist who can zero in on the diagnosis.

Once must note that these symptoms can occur in acute form during a flare-up and subside and even disappear for a while only to reappear again.

If the physician or immunologist suspects Lupus, he/she will recommend a range of lab tests to confirm or at least get a differential diagnosis:

  • Complete blood count – to measure the quantity of red blood cells, white blood cells, platelets
  • Erythrocyte sedimentation rate – this test measures the rate at which erythrocytes settle at the bottom of a test tube. A faster than normal rate usually indicates the presence of an autoimmune disorder. Just ESR alone is not enough to confirm lupus
  • Liver and kidney function tests – to determine functionality as lupus affects these organs
  • Antinuclear antibody test (ANA) – these antibodies produced by the immune system indicates a heightened immune response. Most people with lupus will have a positive ANA. To further confirm lupus, other specific antibody testing may be required
  • Skin biopsy – is done in some cases where lupus has badly affected the skin

Currently, no specific treatment or cure is available for lupus. Treatment is aimed at preventing complications, curbing flares and enabling a fairly normal living. An interdisciplinary team of doctors including pediatricians, neurologists, orthopedicians, pulmonologists and physiotherapists will be required to take care of the clinical needs of the child/adult. Lupus detected early is often more easier to treat. Lupus is treated with a combination of medicines which may change from time to time. Most commonly used medications for lupus include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDS) – NSAIDS like painkillers can be used to treat pain, swelling and inflammation. These medications cannot be prescribed for long-term use as it has a number of side effects
  • Antimalarial drugs – like hydroxychloroquinine can be used to manage flare-ups. Side effects can include upset stomach and eye issues. Regular eye checkups are necessary when taking this medication
  • Corticosteroids – are synthetic drugs which work like the body’s naturally occuring hormones. Corticosteroids help regulate the immune system and reduce inflammation. Prednisone is the most commonly used steroid for lupus. People may be prescribed tablet forms, topical gels or even iv steroids. Usually patients are started with the lowest dosage to control the flare-ups and symptoms. As the patient responds, the steroid dosage may be tapered off or even taken off completely
  • Immunosuppressive drugs – can control an overactive immune system. These are usually used if the person cannot tolerate steroids.
  • Anticoagulants – like low dose aspirin is often used for lupus to manage blood clots
  • Monoclonal antibodies (mAbs) – can disrupt the activity of B lymphocytes. One such drug is Belimubab
Children and adults with lupus must be encouraged to participate in all life activities and must be encouraged to go to regular schools, colleges and participate in social activities. Health counselling and psychosocial counselling must be made available whenever required with other supportive measures.