Lupus is a chronic disease caused by a dysfunctional immune system that leads to one’s own immune system mistaking the body’s cells for foreign invaders and attacking them with inflammatory chemicals. Two people suffering from lupus can exhibit different symptoms, as the nature of the disease is highly individualised. There are approximately 4,000 to 5,000 patients with lupus in Singapore today, with the disease occurring more frequently in women of childbearing age. Studies conducted have shown that Chinese and Indians are more likely to develop the disease as compared to Caucasians.
When people talk of lupus, they are usually referring to systemic lupus erythematosus (SLE). It is named so because SLE is a multisystem autoimmune disease involving multiple organs of the body. An example of SLE is when the patient’s own immune system starts attacking their kidney cells, which leads to inflammation and damage to the kidney cells. The patient’s cardiovascular and nervous systems can also be affected by SLE.
Another form of lupus patients can suffer from is cutaneous lupus, where the lupus is limited to the skin. With cutaneous lupus, skin rashes can occur on the body. These rashes can be either acute, such as with malar rashes, or chronic, such as with discoid rashes.
A form of lupus that can affect newborn babies is known as neonatal lupus, and it may affect babies born from mothers with certain autoantibodies, namely anti-Ro, anti-LA, and anti-RNP. A perfectly healthy woman could end up giving birth to a baby with neonatal lupus, as she might possess the autoantibodies without actually suffering from lupus herself. Neonatal lupus typically only manifests on the baby’s skin and will subside on its own in time.
As lupus affects everyone differently, the disease can be tricky to diagnose, but some common symptoms include a facial butterfly rash appearing across both cheeks, photosensitivity, which means patients are sensitive to ultraviolet (UV) rays from the sun and sometimes even certain types of indoor lighting, as well as joint pain and stiffness. Other common symptoms include hair loss, recurrent oral ulcers, loss of weight, loss of appetite, weakness, anemia, easy bruising and gum bleeding.
Symptoms exhibited, as rheumatologist Dr. Law Weng Giap explains, will also depend on the organ that is being targeted.
“For example, if the kidney is affected, one might have frothy urine, swelling of the limbs, nausea and vomiting,” states Dr. Law. “Meanwhile, if the brain or nervous system is affected, one might suffer from confusion, psychotic symptoms, hallucinations, seizures, or weakness in the limbs.”
Due to lupus being a multisystem disease, a variety of symptoms can occur in different individuals, with symptoms often overlapping with those of many other diseases. Thus, it may take some time for a doctor to actually diagnose someone with lupus. An initial diagnosis might be made based on the symptoms presented, with further laboratory tests being conducted to help confirm or deny the diagnosis. The laboratory tests may include a blood count and urine analysis, with more specific laboratory tests looking out for specific antibodies also being conducted.
Since lupus is a chronic disease with no cure, treatment for the disease will involve taking steps to improve one’s symptoms and prevent further flare-ups.
“The natural history of the course of lupus through life is relapsing and remitting,” says Dr. Law. This means, if properly managed, a lupus patient will have a period of time when their disease is under good control (remission), interrupted by periods of time when the disease is active (flare-ups). Some common causes of flare-ups include non-compliance of their treatment plans, environmental factors such as strong UV exposure, and viral infections such as shingles.
The types of medication prescribed will depend on which organs are involved and the severity of the involvement. Some types of medication that are commonly prescribed include nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and naproxen to alleviate mild pain and swelling in the joints, corticosteroids to reduce swelling and pain, and in severe cases of lupus where the disease targets major organs or other treatments do not work, immunosuppressants may be used.
It can be challenging to have to deal with a chronic disease like lupus, but the best way to manage it is to take the medication according to the dosage prescribed by the rheumatologist.
“If one is unable to tolerate the medications or has any concerns, one should discuss them with the doctor,” advises Dr. Law. “So that all the concerns can be addressed and medications can be adjusted or changed accordingly.”
Lifestyle changes should also be made to help prevent flare-ups, such as exercising regularly and having a balanced low-salt, low-fat, low-sugar diet to prevent the development of hypertension, hyperlipidemia, and diabetes. Apart from these measures, one should live a normal life as much as possible. If well controlled, one’s lupus should be stable and will not worsen with age.
Patients should always aim to maintain their lupus in remission to enjoy a good quality of life.