Questions
- What is Lupus?
- What are some signs and symptoms of lupus or a lupus flare that I might expect and how do I prevent a flare-up?
- How is Lupus diagnosed?
- What are the treatment options for Lupus?
- Is chemotherapy a treatment option for people with lupus?
- Is it safe for me to become pregnant if I have lupus? Are my lupus medications safe to take while I’m pregnant?
- What lifestyle changes do you recommend?
- What is my prognosis and what does the future look like?
This disease was described as early as 1895 ago as a disease of unknown aetiology involving the skin, joints, and variable other organ systems with recurrence as its special feature. Systemic lupus erythematosus (SLE) is a long-term autoimmune disease characterized by the production of autoantibodies which mistakenly attack normal human tissue causing abnormal inflammatory response and damage. Genetic factors do play an important role in people who are susceptible to SLE. Other factors such as gender (e.g. hormonal) and environmental triggers (e.g. ultraviolet light, infection, and toxins) subsequently lead to clinical manifestations.
SLE can affect people of any age group, but women of childbearing age are at the highest risk. Early signs and symptoms like lethargy, weight loss and fever can be subtle and non-specific. Rash, arthritis, and oral ulcers are common. Typically, the rash appears on the face (butterfly or malar rash) and sun exposed area (photosensitive rash). The patient might experience early morning joint stiffness which might gradually progress to pain and swelling. The oral ulcer usually comes and goes and is painless. Involvement of other parts of the body such as the kidney, central nervous system, heart, lungs, and blood vessels can be severe and life threatening.
Diagnosis can be very challenging due to its protean manifestations. SLE cannot be diagnosed based on laboratory tests alone. To make an accurate diagnosis, it is very crucial to consider the clinical picture together with blood tests results, and if required tissue biopsies and imaging. A rheumatologist usually uses certain criteria to aid diagnosis. Antinuclear antibodies (ANA) test is positive in 98% of SLE cases.
Patients with SLE should practise a healthy lifestyle which includes well-balanced, nutritious meals. Supplements such as vitamin D, fish oil and probiotics can be useful. However, other supplements which might stimulate the immune system should be avoided, like alfalfa, echinacea and spirulina. Regular physical activities, adequate rest and smoking cessation are important. In addition, compliance to clinic follow-up and treatment adherence cannot be overemphasized.
Treatment of patient with SLE is very individualized because each clinical subset outcome differs widely. The intensity of treatment is also guided by the severity of the organ system involved. The overall aim is to achieve control of disease activity (inflammation), reduce flare and minimize organ damage. Hydroxychloroquine (an antimalarial) is recommended for all SLE patients unless contraindicated. Corticosteroids is very commonly used and can be lifesaving, but prolonged and high dose usage is associated with many side effects. Other immunosuppressants such as azathioprine, mycophenolate, methotrexate, tacrolimus, and cyclophosphamide are usually given for moderate to severe SLE. Continuous research worldwide also offered more hope for SLE patients with the approval of new targeted therapies belimumab (Benlysta) (2011), anifrolumab (Saphnelo) (2021) and voclosporin (Lupkynis) (2021).
Most women with SLE can have children. Pre-pregnancy planning is essential and SLE should ideally be in remission for at least 6 months prior to conception. A thorough discussion should be made with the managing rheumatologist and some medications which can be harmful to the baby must be stopped or switched several months earlier. Some hospitals have established combined clinics with the obstetrician.
Dr Ong Yew Chong
Pantai Hospital Cheras (PHC)
Internal Medicine, Rheumatology
