Lupus: Symptoms, Diagnosis, And Treatment

Lupus, also known as systemic Lupus erythematosus(SLE), is a chronic, multi-systemic,  autoimmune disease which could affect any part of the body. It predominantly affects systems like skin, mucosal surfaces, joints, kidneys, liver, blood cells, cardiovascular system, and nerves.

Age Groups Affected by Lupus

SLE predominantly affects patients in the age group of 16-45 years. It is nine times more predominant among females than males and can also affect kids and the elderly population over sixty years of age. The general presentation among kids and elderly individuals differs from the  16-45-year-old population.

Systemic Manifestations of Lupus

Lupus can affect joints, skin, mucosal surfaces, hair, blood cells, kidneys, heart, and respiratory system. Let’s check out its symptoms in detail, Listed by the best rheumatologist in Mysore are the following:

• Joints

When lupus affects joints, it predominantly presents as pain in small and large joints in both upper and lower limbs, associated with swelling and early morning stiffness lasting more than 30 minutes duration. It can affect one or more joints, to begin with, or multiple joints simultaneously.

• Skin

Skin involvement is very important in patients with lupus. It most often presents as a malar rash, a butterfly-shaped rash predominantly seen over the nasal bridge and cheeks, along with other areas exposed to the sun. So, it predominantly affects the sun-exposed parts of the body.  It can also appear as blistering, psoriatic, annular, livedoid, or burnt-out or scarring lesions called  DLE.

• Blood

Lupus often involves blood cells. It can involve one or more cell lines. So, it can affect  RBCs (red blood cells), WBCs (white blood cells), or platelets, and they can be affected altogether or in a single cell line. Certain patients have isolated thrombocytopenia manifested as bleeding manifestations in the form of haemoptysis bleeding under the skin, or bleeding from the gums.  Lupus often presents as jaundice, a manifestation of haemolysis, which could happen because of the destruction of RBCs in the periphery, which bear the antibodies over their surface.

• Kidneys

When there is involvement of kidneys, lupus can present as anaemia, raised blood pressure, or swelling of lower limbs. Patients also present as passing high-coloured urine or bleeding in the urine.

• Cardiovascular System

Lupus can affect the cardiovascular system in the form of cardiomyopathies, endocarditis, myocarditis or pericarditis, coronary artery diseases, or vasculitis.

• Respiratory System

When lupus affects the respiratory system, it can present in the form of serositis in the form of pleural effusion, interstitial lung disease, or pulmonary hypertension.

Lupus in Females 

In females of the reproductive age group, lupus can present as recurrent pregnancy loss in the form of recurrent abortions, stillbirths, or pregnancy-induced hypertension complications like eclampsia and preeclampsia. Those bearing certain specific antibodies can also transfer the antibodies transplacentally to the baby, causing neonatal lupus. This type of lupus can cause skin lesions similar to lupus patients, but it is suffering and doesn’t require medication.

Evolution of Lupus

Lupus can start with skin manifestations and, if uncontrolled, can spread to other body parts.  It can start with the joints and then involve the skin and then other parts of the body. There can be isolated involvement of the kidneys. 

Investigations in Lupus

General investigations at the best hospital for lupus treatment in Mysore require the following:

• Checking the complete blood count.

• The direct Coombs test for jaundice and anaemia.

• Urine routine to look for active urine sediments and passage of RBCs and proteins in the urine.

Thyroid function test, including TSH, freeT4, and T3, liver function test, kidney function test, chest X-ray, and ECG. 2D echocardiography may be required in some conditions.

• Specific investigations for the diagnosis of lupus include the following:

• Skin Biopsy is a test to demonstrate antibody or complement deposition in the dermo-epidermal junction.

• ANA (Antinuclear Antibody) tests by the immunofluorescence method, ANA profile,  complements.

• In cytopenias, the patient may or may not require bone marrow to look for cytopenias other than lupus.

• A kidney biopsy is required in case of active urine sediments, with or without hypertension and swelling in feet.

Management of Lupus: 

Strict photoprotection by following methods: 

• The sunscreen lotion should be applied every 4-5 hours or to exposed parts of the body.

• Among the pharmacological modalities of treatment, steroids are the mainstay of treatment. They can.be used topically or systemically, depending on the system affected.

• As steroids cannot be given for long-term drugs, drugs called disease-modifying antirheumatic drugs are used. The drugs chosen for a patient depend on the disease manifestations, gender, age, reproductive capacity, the presence of complications, or allergy to certain medications.

• Certain medications must be included in the treatment regimen for patients planning pregnancy, are pregnant or post-delivery, especially the ones with clotting abnormalities.

• Patients who are taking steroids must be supplemented with Calcium and Vitamin D as steroids can cause weakening of the bones and fluctuations in blood pressure and blood sugar. 

• Close monitoring and regular follow-up concerning medications, including reducing and increasing dosages, are necessary. Initially, follow-ups are done once every four weeks and then once every three months when the disease is under control. 

• Knowing the symptoms and adverse effects of lupus can help you and your family prepare well to manage it. Working closely with your doctor to formulate a personalised treatment plan at the best hospital for lupus treatment in Mysore is essential. It allows you greater control over managing the disease and maintaining overall health and well-being. 

FAQs related to Lupus

• How is lupus diagnosed? 

Lupus is diagnosed through a combination of general and specific investigations. These include complete blood count, urine routine, thyroid function tests, skin biopsy, and ANA (Antinuclear  Antibody) tests. The inflammation of lupus affects the blood and bone marrow in several ways. read the blog on Bone Marrow Biposy and Aspiration for more details.

• Is lupus heritable? 

Typically, Lupus is not heritable. As per studies, there is only a 5% chance of that happening.

• Is lupus curable? 

Currently, lupus has no permanent cure. However, we can manage it to a great extent with medications and lifestyle changes to reduce symptoms and prevent flares.