Lupus: The disease with a thousand faces

Many are unaware of lupus and its potentially life-threatening complications. Lack of lupus awareness is a contributing factor to late diagnosis, social stigmas and increased burden on healthcare systems.

Lupus is an incurable autoimmune disease which occurs when your immune system becomes hyperactive and mistakenly attacks your own healthy tissues, causing inflammation and damage to various tissues and organs in your body. Normally, the immune system produces antibodies to fight against foreign infectious agents such as viruses, bacteria, and other microbes. However, in lupus, antibodies are produced which target your normal tissues rather than foreign invaders, causing inflammation and increased susceptibility to infections. These antibodies are known as auto antibodies.

Following the normal shedding of old dead cells from different organ systems, lupus auto antibodies attack the nucleus of these old cells. This may cause the complex of antibodies and dead cells to deposit in the joints and in different organs such as the liver, kidneys, lungs, heart and gastrointestinal tract, which may lead to severe organ damage and widespread inflammation. The different organ system involvement results in a wide range of symptomatic expressions which often delays a timely diagnosis.

Lupus strikes both males and females, but it disproportionately affects women as 90% of people affected are women. The women affected are usually of reproductive age between 15 and 44 years. Lupus is one of the leading causes of death among women of African descent. Black women are three times more likely to get lupus and experience severe disease progression and organ system involvement than white women. Studies have shown that black people were significantly younger than white people when they died of lupus. This makes lupus a very relevant disease in Jamaica. Even though the cause of lupus is unknown, there is a genetic predisposition as family members of affected individuals have a five to 20 per cent chance of acquiring lupus. There have also been reports of environmental risk factors such as smoking, obesity and stress, as well as hormonal risk factors such as oestrogen-based oral contraceptives. Lupus is not contagious, which means that it cannot be transmitted to another person through close contact or sex.

Lupus can manifest in many ways which may differ from person to person. One of the most distinctive features of lupus is a butterfly shaped facial rash unfolding across the nose and cheeks. Other multitude of symptoms include sun sensitivity, seizures, unexplained fatigue, fever, hair loss, swollen and painful joints and muscles, as well as recurring mouth sores. Even though some symptoms are permanent, some patients may experience occasional flares, followed by a period free of symptoms called remissions. Some people experience these symptoms for years before lupus is suspected and diagnosed. Unfortunately, if left untreated, these symptoms can cause severe illness and even death. Therefore, it is important to establish an early diagnosis to treat the disease more effectively.

DIFFERENT TYPES OF LUPUS

Different types of lupus have been identified. However, systemic lupus erythematosus (SLE) is the most common and most serious type, accounting for about 90 per cent of lupus cases. SLE can affect multiple organ systems in the body such as the heart, nervous system, lungs, kidneys, skin, and joints. Other less common forms of lupus include Neonatal Lupus Erythematosus (NLE), Cutaneous Lupus and Drug Induced Lupus (DIL). In NLE, the mother’s auto antibodies cross the placenta during pregnancy, affecting the skin of infants. Fortunately, this usually resolves within months following birth. In Cutaneous Lupus, the skin is primarily affected resulting in raised, thick rashes on the face, neck, and scalp. Internal organs are not usually affected. However, about 10% of patients with Cutaneous Lupus usually progress to SLE. DIL occurs following exposure to certain medications in individuals that are genetically predisposed to lupus. The antihypertensive drug hydralazine, heart arrythmia medication procainamide and isoniazid antibiotic are some of the drugs commonly associated with this type of lupus, but it usually resolves following discontinuation of the culprit medication. If you have a family history of lupus, it might be worthwhile to communicate this to your doctor so that these medications can be avoided.

Lupus has no cure but can be treated to manage the symptoms and prevent organ damage. Management is usually personalised based on each person’s symptoms. Therefore, if you are affected by lupus, it is important to see your doctor regularly and adhere to your prescribed treatment. Wearing sunscreen and avoiding excessive exposure to sunlight is crucial, as UV light may trigger the disease and cause flare-ups. Stressful situations and smoking should be avoided, and you should practise frequent handwashing as lupus patients are at increased risk for infections. Lifestyle modifications to improve overall health, including physical activity, getting adequate rest, and consuming healthy meals may be useful in persons with lupus. If you are consistently experiencing symptoms commonly associated with the disease, it might be worthwhile to visit your doctor to assess whether these signs point to the possibility of lupus. Early diagnosis of lupus is essential for improved survival and quality of life of lupus patients. Those affected by lupus should join support groups which may provide ongoing support to manage the disease and its symptoms.

Melisa Anderson Cross is a clinical chemistry lecturer in the College of Health Sciences at the University of Technology, Jamaica.