Lupus

Lupus is about nine times more common in women, particularly those aged 15-45, though it can affect any age. While rare in children, its prevalence is 1/1000, making it more common than leukemia. SLE's causes include genetic predisposition, hormonal factors, and environmental triggers such as infections, sunlight, and certain medications.

Although Lupus can affect any part of the body, from the skin and joints to major organs like the kidneys, heart, lungs, and brain, not all organs are affected in every patient. Some patients have only skin and joint involvement, while others may also have kidney and brain involvement. Symptoms depend on the organs affected and can vary widely between patients.

Common symptoms include:

• Extreme fatigue (tiredness)
• Painful or swollen joints
• Fever
• Anemia (low hemoglobin)
• Swelling (edema) in feet, legs
• Skin rash
• Sun- or light-sensitivity (photosensitivity)
• Hair loss
• Mouth or nose ulcers

Lupus is diagnosed by a physician based on clinical symptoms and positive results for ANA (Antinuclear Antibody). After diagnosis, the physician assesses which systems are affected by conducting blood and urine tests.

• Antinuclear Antibody (ANA) Test: Detects antibodies against the cell nucleus, common in lupus.
• Anti-DNA and Anti-Smith Antibodies: Specific indicators of lupus, particularly with kidney involvement.
• Complete Blood Count (CBC): Identifies anemia, leukopenia, or thrombocytopenia.
• ESR and CRP: Measure inflammation levels.
• Urinalysis: Checks for kidney involvement.
• Complement Levels (C3 and C4): Low levels suggest active lupus.
• Organ Function Tests: Assess kidney and liver health.
• Biopsies: Confirm lupus and evaluate affected skin or kidneys.

• Early diagnosis of lupus is crucial, as a missed diagnosis can be life-threatening.
• With early detection, SLE can be effectively treated, resulting in very good outcomes for over 90% of patients.

• Immune System Modification:
  • Various medications are available to mitigate immune cell attacks on different organs.
  • Early intervention with non-steroidal drugs can reduce reliance on steroids and prevent joint damage.
• Hydroxychloroquine:
  • Treats skin rashes and other lupus manifestations effectively.
  • Widely used in lupus management due to its broad spectrum of benefits.
• Other Medications:
  • Steroids, azathioprine, cyclophosphamide, mycophenolate, among others, are commonly prescribed by rheumatologists.
  • Selection of drugs and treatment modalities depends on the affected organ and individual patient factors.
• Medical Supervision:
  • Treatment decisions, drug usage, and duration are determined by a rheumatologist.
  • Self-medication or discontinuation of medications without medical advice is extremely dangerous.
• Regular Follow-Up:
  • Scheduled follow-up appointments with doctors are necessary for monitoring and adjusting treatment.
  • Blood and urine tests are essential as per the doctor's recommendations to assess treatment efficacy and detect any adverse effects.
• Communication with Doctor:
  • Keep your doctor informed about any issues experienced during treatment or the development of new symptoms.
  • Promptly report any concerns or adverse reactions to ensure timely adjustments to the treatment plan.

Over the past two decades, significant strides have been made in lupus research, thanks to dedicated researchers achieving major breakthroughs. These advancements have led to noticeable improvements in patient care and overall quality of life for individuals living with lupus.

Scoring systems in lupus aim to quantify disease activity and monitor treatment response, aiding in clinical decision-making. Examples include:

• Systemic Lupus Erythematosus Disease Activity Index (SLEDAI): Assesses lupus activity based on 24 clinical and laboratory parameters.
• British Isles Lupus Assessment Group (BILAG): Evaluates disease activity across multiple organ systems using a graded scoring system.
• Systemic Lupus Activity Measure (SLAM): Quantifies lupus activity through a comprehensive assessment of symptoms and organ involvement.
• Systemic Lupus International Collaborating Clinics (SLICC) Damage Index: Tracks cumulative organ damage over time, guiding long-term management strategies.

These scoring systems play a crucial role in guiding treatment decisions and monitoring disease progression in lupus patients.