Lupus – when your body attacks itself

DR FAITH BYISRAEL

As a health educator, I’ve had to learn about a wide range of diseases. After seeing a lupus awareness month post from a friend recently, I recognised that I didn’t know anything about lupus. Here is what I’ve learned about this disease since then.

Lupus Awareness Month

According to the Lupus Foundation of America, May has been designated as Lupus Awareness Month. This year the theme is Let’s Make Lupus Visible, with an aim of rallying “family, friends and community to raise funds and awareness of the invisible physical, emotional and financial impact of lupus.” On May 21, individuals were encouraged to wear purple to health make Lupus visible.

What is lupus?

According to the Mayo Clinic, lupus is a disease that “occurs when your body's immune system attacks your own tissues and organs (autoimmune disease). Inflammation caused by lupus can affect many different body systems, including your joints, skin, kidneys, blood cells, brain, heart and lungs.

Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus is a facial rash that resembles the wings of a butterfly unfolding across both cheeks, and it occurs in many but not all cases of lupus.

Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. While there's no cure for lupus, treatments can help control symptoms.

Symptoms of lupus

Lupus looks different in different people. Signs and symptoms may develop slowly for some, but rapidly for others; mild for some but severe for others; and temporary for some but permanent for others. The signs and symptoms each person experiences are dependent on the part of the body affected. The most common include:

• Fatigue

• Fever

• Joint pain, stiffness and swelling

• Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body

• Skin lesions that appear or worsen with sun exposure

• Fingers and toes that turn white or blue when exposed to cold or during stressful periods

• Shortness of breath

• Chest pain

• Dry eyes

• Headaches, confusion and memory loss

What causes lupus?

Lupus is an autoimmune disease. That means that your immune system sees and attacks healthy tissue in your body, thinking that they are foreign bodies like viruses or bacteria. According to the Mayo Clinic, “It appears that people with an inherited predisposition for lupus may develop the disease when they come into contact with something in the environment that can trigger lupus. The cause of lupus in most cases, however, is unknown.” Some of the environmental factors that seem to trigger lupus include:

• “Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people.

• Infections. Having an infection can initiate lupus or cause a relapse in some people.

• Medications. Lupus can be triggered by certain types of blood pressure medications, anti-seizure medications and antibiotics. People who have drug-induced lupus usually get better when they stop taking the medication. Rarely, symptoms may persist even after the drug is stopped.”

Complications of lupus

Many areas of your body can be affected by lupus. These include:

1. Kidneys. Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus.

2. Brain and central nervous system. If your brain is affected by lupus, you may experience headaches, dizziness, behaviour changes, vision problems, and even strokes or seizures. Many people with lupus experience memory problems and may have difficulty expressing their thoughts.

3. Blood and blood vessels. Lupus may lead to blood problems, including a reduced number of healthy red blood cells (anaemia) and an increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels.

4. Lungs. Having lupus increases your chances of developing an inflammation of the chest cavity lining, which can make breathing painful. Bleeding into lungs and pneumonia also are possible.

5. Heart. Lupus can cause inflammation of your heart muscle, your arteries or heart membrane. The risk of cardiovascular disease and heart attacks increases greatly as well.

Treating lupus

Of course, the treatment depends on your specific signs and symptoms. According to the Mayo Clinic, the most common treatments include:

• “Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), may be used to treat pain, swelling and fever associated with lupus. Stronger NSAIDs are available by prescription. Side effects of NSAIDs may include stomach bleeding, kidney problems and an increased risk of heart problems.

• Antimalarial drugs. Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), affect the immune system and can help decrease the risk of lupus flares. Side effects can include stomach upset and, very rarely, damage to the retina of the eye. Regular eye exams are recommended when taking these medications.

• Corticosteroids. Prednisone and other types of corticosteroids can counter the inflammation of lupus. High doses of steroids such as methylprednisolone (Medrol) are often used to control serious disease that involves the kidneys and brain. Side effects include weight gain, easy bruising, thinning bones, high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and longer term therapy.

• Immunosuppressants. Drugs that suppress the immune system may be helpful in serious cases of lupus. Examples include azathioprine (Imuran, Azasan), mycophenolate (Cellcept), methotrexate (Trexall, Xatmep, others), cyclosporine (Sandimmune, Neoral, Gengraf) and leflunomide (Arava). Potential side effects may include an increased risk of infection, liver damage, decreased fertility and an increased risk of cancer.

• Biologics. A different type of medication, belimumab (Benlysta) administered intravenously, also reduces lupus symptoms in some people. Side effects include nausea, diarrhoea and infections. Rarely, worsening of depression can occur.

Rituximab (Rituxan, Truxima) may be beneficial for some people in whom other medications haven't helped. Side effects include allergic reaction to the intravenous infusion and infections.”

If you live in Trinidad and Tobago and you’ve been diagnosed with lupus, or the your signs and symptoms look like you may have lupus, I encourage you to contact The Voice of Lupus Foundation (Facebook: https://www.facebook.com/thevoiceoflupusfoundation; email voiceoflupus@gmail.com; or telephone (868) 327-0220). You do not have to deal with lupus alone.

Dr Faith B Yisrael is a health educator, social scientist, public health specialist and politician.

Email: Imani.Consulting.Tobago@gmail.com

Phone: 494-8827

Facebook: @ImaniConsultingAndFoundationTobago