World Lupus Day 2018

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Celebrating World Lupus Day, May 10, 2018

WHAT YOU SHOULD KNOW ABOUT LUPUS

Lupus on the face imageI first heard the word Lupus in the intriguing medical drama, House, M.D.

The misanthropic diagnostician, Gregory House and his team of enthusiastic interns never fail to ask, “Could be Lupus, you know?” whenever they are faced with a patient whose diagnosis they haven’t quite cracked.

Six years later, now in my final year in med school, I’ve seen quite a number of similar cases in the clinic to understand why Lupus was a usual suspect for Gregory House; it presents pretty much the same symptoms as many other diseases.

What is Lupus?

Lupus is an autoimmune disease that causes your body’s defences to fight itself. Sounds crazy, right?

Well, here’s the thing. As your body cells die, they sometimes project something called self-antigens on their surfaces. Normally, the warriors in your body, the T and B cells don’t recognize these self-antigens.

However, in autoimmune conditions like Lupus, your body cannot properly control these warriors, so they recognize these self-antigens as foreign bodies, and attack them ferociously, causing inflammation of your body tissues.

This is what happens in a common form of Lupus: Systemic Lupus Erythematosus (SLE).

What Causes Lupus?

While the actual cause is unknown, several factors may put you at risk of developing Lupus, including:

  • Genetic Abnormalities
  • Heredity: It runs in families, although its heritability is low
  • Drugs: Several drugs like Hydralazine (an antihypertensive), Procainamide (used in managing heart rhythm abnormalities) and Phenytoin (used in treating seizures)
  • Exposure to ultraviolet sun rays
  • Infectious agents like the Epstein Barr Virus

Lupus is three times more common in women than in men, and it is even commoner in premenopausal, black women.

What are Lupus’ Signs and Symptoms?

Lupus has been referred to as the “great imitator.” Its signs vary from person to person, and it’s often mistaken for other diseases. Common Lupus symptoms include:

  1. Muscle and Joint Pain:

As high as 90% of people with Lupus experience a form of joint pain (arthralgia) and/or inflammation (arthritis). About 50% will also come down with muscle pain (myalgia). These usually respond well to NSAIDS like Aspirin, Ibuprofen.

  1. Skin Manifestations:

More than two-thirds of people with Lupus will develop a form of skin disease. Lupus affects the skin in three ways:

  • Acute Cutaneous lupus: Here, there is an erythematous rash on the face. It usually appears on both cheeks and across the bridge of the nose, giving it the shape of a butterfly. The rash may also be photosensitive.
  • Discoid lupus: The rashes are round with well-defined borders and they may progress to scar formation and pigmentation.
  • Subacute Cutaneous Lupus: This is a rare form characterized by erythematous, scaly lesions that occur in unexposed areas of the body. They don’t usually itch but may become pigmented.
Pics credit: https://emedicine.medscape.com/article/1065529-clinical

Pics credit: https://emedicine.medscape.com/article/1065529-clinical

In people with black skin, the rashes may first appear as flat or raised patches that are purplish black in colour, and in some cases, are darker than the surrounding skin. Besides the face, other common areas affected include the ears, chin, V region of the neck and chest, upper back, and
inner surfaces of the arms.

Some of the challenges people face with the skin manifestations include the cosmetic implications of the prominent rashes on their face and the alopecia that may ensue when the rash occurs on the scalp.

  1. Other features include:
  • Heart conditions like pericarditis, endocarditis
  • Nervous disorders like convulsions, paralysis, or hallucinations
  • Kidney abnormalities
  • Chest pain
  • Fever
  • Fatigue
  • Weight Loss
  • Pale or purple fingertips
  • Depression etc.

What Do You Do When You Notice These Symptoms?

The best thing to do is to see a certified Physician. Don’t hesitate.

By combining information gotten from a complete medical history, physical examination and some laboratory tests, he or she would be able to make a diagnosis.

There is no cure for Lupus, but a multidisciplinary approach involving rheumatologists, haematologists, dermatologists, cardiologists, neurologists etc. would ensure that all possible clinical features of Lupus are managed effectively.

Treatment goals would revolve around reducing the risk of organ damage, and treating flares when they occur.

What Do You Not Do When You Notice These Symptoms?

  • Wish them away without seeing a doctor
  • Go to the nearby chemist to self-medicate
  • Rub any weird ointment your neighbour advises you to rub; palm oil, vegetable oil, early morning urine, charcoal etc.
  • Lock yourself inside your room forever: there are many effective ways of managing your symptoms

Serious complications such as kidney failure, heart attacks, miscarriages, cancer, severe anaemia, and immunodeficiency, may arise when you do some of these things listed above and refuse to see a doctor.

So, if you notice any of the symptoms of lupus, report to the Physician in a tertiary health centre nearest to you.

Remember, the earlier, the better.

 

Written by Darlington Ekene Ogugua.

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