Systemic Lupus Erythematosus (Lupus) Treatment in Delhi, India

Lupus presents differently in different individuals; hence, no two cases are alike. Symptoms may come and go and may develop suddenly or slowly. Lupus is characterised by a flare-up of symptoms.

The appearance of symptoms depends on the part of the body affected. Some common ones include:

• Fatigue
• Fever
• A butterfly-shaped rash on the face expanding from cheek to cheek through the bridge of the nose.
• Rashes any part of the body.
• Chest pain
• White or blue discolouration of fingers and toes on exposure to cold or stress.
• Dry eyes
• Shortness of breath
• Joint pain, stiffness and swelling.
• The appearance of skin lesions or their worsening with sun exposure.
• Headaches, confusion and memory loss.

Lupus is an autoimmune disease. It occurs when the body's own immune system attacks the healthy tissue of the body. Lupus likely results from a combination of mutated or abnormal genes and the environment. However, its exact cause is still unknown. Some potential causes that trigger are:

• Sunlight: Exposure to sunlight triggers flare-ups in people with inherited SLE genes. Most skin lesions develop due to a reaction to sunlight.
• Infections: Infections tend to initiate lupus or sometimes cause relapse in some people with a history of SLE.
• Medications: Lupus is known to be triggered by anti-seizure medications, blood pressure medications, and antibiotics. People with drug-induced lupus feel better once the medicines are stopped. Rarely, the symptoms may persist despite stopping the drugs.

The diagnosis of systemic lupus erythematosus is difficult compared to other disorders. This is because this disease presents differently in different individuals. In addition, signs and symptoms of lupus may change over time.

For diagnosing lupus, one test is not enough. Instead, the combination of blood and urine tests, signs and symptoms, and physical examination findings help diagnose lupus.

Blood and urine tests may include:

• Complete Blood Count: This test helps assess the number of healthy red blood cells, white blood cells and platelets, along with levels of haemoglobin in the blood. Often, people with lupus are diagnosed with anaemia and low white blood cells or platelet count.
• Erythrocyte Sedimentation Rate: This blood test helps evaluate the rate at which the red blood cells settle at the bottom of the testing tube within an hour. In patients with lupus, it is often quicker than normal. In case of associated infection, cancer or an inflammatory condition, ESR is elevated.
• Kidney and Liver Assessment: Kidney and liver function tests allow doctors to check their functioning and whether they have been affected by the disease or not.
• Urinalysis: Elevated levels of proteins or red blood cells may be observed in urinalysis. This indicated renal involvement in the disease.
• Antinuclear Antibody (ANA) Test: This test determines the presence of antibodies whose presence indicates an active immune system. Also, a point to note is that people with lupus have a positive ANA test, but every person with a positive ANA test may not have lupus.

• X-ray of the Chest: An X-ray image of the chest may reveal any abnormal shadows that indicate fluid or inflammation in the lungs.
• Echocardiogram: Sound waves are used to produce real-time images of the beating heart. It helps determine problems with the valves and other parts of the heart.

A renal biopsy helps understand the damage lupus does to the kidneys. Moreover, it helps diagnose the condition and the severity of kidney disease. A skin biopsy may help if lesions are observed on the skin.

The treatment plan for lupus is formulated based on the evident signs and symptoms. Some commonly prescribed medicines include:

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): NSAIDs help alleviate pain, swelling and fever caused by lupus.
• Anti-malarial Drugs: Anti-malarial drugs such as hydroxychloroquine affect the immune system and help lower the risk of lupus flare-ups.
• Corticosteroids. Prednisone and other corticosteroids help lower inflammation with lupus. High doses of steroids help control serious renal and brain diseases. Some common side effects include weight gain, easy bruising, diabetes, thinning bones, high blood pressure, and increased risk of infection.
• Immunosuppressants: These drugs act by suppressing the immune system and reducing their action against the body. It helps most cases with lupus, for example, azathioprine, mycophenolate, methotrexate, and cyclosporine. However, they, too, carry certain side effects, such as the increased risk of infection, decreased fertility, liver damage, and cancer.
• Biologics: Belimumab lowers symptoms of lupus when administered intravenously. However, it has certain side effects, such as diarrhoea, nausea, and infections. Rarely worsening of depression can occur. Another such biologic is rituximab.

The risk factors that may help with the development of lupus include:

• Sex: Lupus has been shown to have a female predilection.
• Age: Lupus tends to affect people of almost all ages, but it most commonly affects people between the ages of 15 and 45.
• Race: Lupus is common in people of African-American, Hispanic and Asian American ethnicity.

Lupus causes inflammation and affects various areas of the body, such as:

• Brain and Central Nervous System: People with lupus affecting the brain may experience dizziness, headaches, vision problems, behaviour changes, and even strokes or seizures. In addition, people have difficulty remembering things and expressing their thoughts or emotions.
• Bone Tissue Death: If the blood supply to the bone is compromised, the one tissue does not receive the nutrition it needs to survive and, as a result, dies. This means that the bone becomes brittle, weak and prone to fractures.
• Blood and Blood Vessels: People with lupus may develop anaemia due to a decline in the number of healthy RBCs. In addition, they are at a higher risk of clotting blood and bleeding. Inflammation of blood vessels is also a problem they commonly face.
• Heart: Heart muscles, membranes, and arteries are also at risk of inflammation. Hence, the chances of the development of cardiovascular disease and cardiac arrest are common.
• Kidneys: Renal damage and failure are also very common in people with systemic lupus erythematosus.
• Lungs: Inflammation in the chest makes breathing difficult, and people with lupus are more prone to having pneumonia and bleeding into the lungs.
• Infection: Since the disease is autoimmune, people are given immunosuppressants to suppress the activity of the immune system. This attracts plenty of infections if the patient is not careful. These medicines weaken the immune system, making the body incapable of fighting infections.
• Cancer: Systemic lupus erythematosus is known to contribute to the development of cancer.
• Pregnancy Complications: Miscarriage is common among women with systemic lupus erythematosus. In addition, it increases the risk of developing high blood pressure during pregnancy and preterm birth. Doctors recommend delaying pregnancy for at least six months of controlled disease episodes. This helps avoid any such complications during pregnancy.

Living with SLE can be a little challenging. However, joining support groups helps deal with the condition better. Alternatively, counselling therapy helps with better management of mental health, lowers stress, and develops a positive attitude.

SLE affects every individual differently. However, treatments become highly effective with a positive attitude and an early start. Therefore, schedule an appointment with the doctor immediately if any discomfort or symptom is experienced.