Lupus — A chronic, multi-system condition that affects the entire body

IT’S an autoimmune disease which tends to affect a greater number of women — a chronic, multi-system condition that affects the entire body.

Internist at Imani Medical Centre, Papine Plaza, Dr Samantha Nicholson, said with lupus the body is basically fighting and destroying itself, which is why many patients with lupus often suffer multiple organ failure or failure of several major organs.

Dr Nicholson pointed out that the lifelong condition, often referred to as “the great imitator”, is often difficult to diagnose because it presents with a number of smaller signs and symptoms, especially in the earlier stages which are either overlooked or misdiagnosed since the condition tends to mimic other conditions such as fibromyalgia, bone disease, blood disorders and rheumatoid arthritis.

She explained that since lupus often wreaks havoc on so many different organs, there is often a multitude of specific and non-specific signs of symptoms that a patient may experience. She shares the list of non-specific signs below:

• Extreme fatigue

• Headaches

• Weight loss

• A rash which is described as a butterfly rash because it is on the cheeks and the nose

• Joint pains such as in the elbows, wrists, knees, and your joints may or may not be swollen

• Hair loss, which can be quite profound, and in the case of women this may often be mistaken as a classic case of chemical damage in the case of women with processed hair.

In the case of discoid lupus, which is a kind of lupus which is confined to the skin and hair, the patient may present with the following:

• Scarring (this may be as a result of rashes or because of lesions which often turn to sores)

• Mouth or nose ulcers

• Recurrent chest pains

• Photosensitivity (This is sensitivity to light or the sun, which makes the associated butterfly rash more pronounced once you are exposed to them).

However, when these non-specific symptoms are accompanied by more suggestive organ-specific signs and symptoms, then a diagnosis at this point is usually much clearer. Dr Nicholson shared some of the most noted associated organ-specific symptoms below:

Cardiopulmonary symptoms

•Pericarditis — This refers to swelling and irritation of the lining of the heart. Dr Nicholson said that you can get severe pain over the heart, which won’t relent and it can be recurrent. In addition, the patient may suffer shortness of breath.

• Pleurisy — This refers to a condition of the lung which causes sharp chest pain which worsens during breathing. Coughing is also associated with this condition.

• Patients may also suffer heart attacks and infections of the heart.

Haematological symptoms

• “Patients may suffer from blood clots which are usually in the leg or most commonly the calf; this is called deep vein thrombosis. This is normally marked by unexplained swelling and pain,” Dr Nicholson said.

•Blood clots can also travel to the lungs from the legs and in rare cases other parts of the body. This is known as pulmonary embolism and it can be fatal. The patient may also present with chest pains and shortness of breath.

•Lupus often destroys your red blood cell platelets which may result in anaemia or what is referred to as thrombocytopenia which is a platelet deficiency. “This increases the possibility of bleeding which can be catastrophic especially if you bleed into your head which can result in a stroke which could be fatal,” Dr Nicholson explained.

She further pointed out that the anaemia can be so bad that you need a blood transfusion, but if you are going to react against your own blood cells and destroy them, when you get blood from a donor you will destroy that as well, making it difficult to treat.

Kidney complications

From seeing discoloured urine to blood in the urine all the way up to kidney failure, lupus is a leading cause of kidney failure and the need for dialysis. Another manifestation of kidney failure is swelling in the entire body.

Lupus Nephritis refers to the inflammation of the kidneys in lupus patients. It may also lead to kidney failure.

Brain and central nervous system

•Patients can get brain disease such as strokes.

• Seizures can also be linked to a previous stroke or be completely unrelated.

• You can also get psychosis, any mental illness really, but psychosis is known as a classic so you will start hearing things, seeing things, become incoherent, being aggressive. People may also become depressed, extremely anxious and have thoughts of suicide.

If a doctor suspects lupus or is considering the possibility of lupus, he will order a number combination of blood and urine tests since no one test can be used to diagnose lupus. In addition to test results, the signs and symptoms and findings of the physical examination will be used to form the diagnosis.

“Once a diagnosis is made then the course of treatment can be discussed. Unfortunately, most of the medications used to treat lupus have plenty of side effects. One of the common ones is Prednisone and other types of corticosteroids. Steroids have a long list of complications — diabetes, weight gain, and they increase the risk of infections,” Dr Nicholson advised.

She said other drugs used are similar in make up to chemotherapy drugs and so the side effects are similar to those seen in patients undergoing chemotherapy, such as an increase in the risk for infection, liver disease and even kidney impairment. In addition to this, they are also quite expensive too, and the disease can also severely hamper a person’s productivity at work.