Know lupus to save life

Systemic lupus erythematosus (SLE) also known as lupus. It is one of the chronic prototype systemic autoimmune often fatal disease which is under diagnosed . To increase awareness regarding this disease, May 10 every year considered as lupus day through out the globe. Any one and any part of the body can be affected by this disease.

The initial symptoms mimic the symptoms associated with most common diseases like upper respiratory tract infections. Hence the diagnosis in early stage is often missed unless and until a strong suspicion of this disease is made. As Rheumatologist is the expert in diagnosing it even in early stages, it is utmost important to consult a qualified rheumatologist as early as the suspicion of this disease is done.

Course of the disease: this disease has variable course .It may be asymptomatic, may have very minor manifestations or may have life threatening features leading to increased mortality. Untreated early in the disease course, the disease is fatal. With the introduction of newer drugs including steroids the survival in these patients has improved dramatically The cause of the disease is not yet clear. It was believed that interaction between genes and environment play a role in susceptibility to the disease.

The risk of disease is increased in smokers. Some viral infection also predispose to increased risk of the disease. UV light, physical and psychological stress also precipitates flare of the disease. The immune system of our body normally protects our body from external insults like infections etc.

It is predominantly a disease of women of childbearing age. It can occur in children and in males where in they have accelerated disease with greater baseline damage, poor long term prognosis than female counterparts. In pregnancy the disease is challenging particularly if the disease is active 6 months prior to conception. It leads to recurrent abortions, low birth weight babies or still births .

It can also occur in infants born to mother with lupus which is called neonatal lupus. In such cases, neonate or infant is at risk of heart blocks. Lupus flares during postpartum period. Hence it is important to counsel the female particularly when planning pregnancy regarding the said complications, the need to identify neonate at risk of heart blocks, need for prompt initiation of therapy to control disease activity which help to improve maternal outcome and fetal survival.

In the first two years of disease onset risk of kidney involvement is high. If this is neglected it leads to permanent kidney damage. Kidney involvement can be identified early by following signs and symptoms: Swelling of legs, early morning puffiness of face, increase in blood pressure, and increased frequency of urination in the night.

Laboratory testing will have evidence of protein loss in urine. It requires kidney biopsy and treatment depends on the stage of kidney disease. Most of the patients have fear to undergo kidney biopsy due to false beliefs. But it is imperative to know the stage of the disease to plan treatment.

Heart, Lung Stomach and intestines are affected in lupus. These patients are at risk of subclinical atherosclerosis leading to fatal myocardial ischemia and death. Any layer of heart is affected. They can present with chest pain, sudden onset of breathlessness, swelling of body or heart attack. Sometimes there will be collection of fluid around the heart leading to heart compression and is fatal.

Precautions:

• As these patients are at risk for catching infections, some precautionary measures like wearing a mask in crowded area, avoiding contact with infected person, vaccination as per the schedule decrease risk of fatal infections in them.
• Should have a healthy balanced diet, calcium rich foods.
• Improve the capability to self identify warning signs predicting flare so as to seek early consultation for prompt therapy.
• Regular follow up with rheumatologist, using drugs only under supervision.
• Regular exercise can have enormous benefits.

The Writer is Consultant Rheumatologist, KIMS Hospitals.

By Dr Vijaya Prasanna Parimi