World Lupus Day: In Conversation with Dr. Yogesh Singh, Consultant Rheumatologist, Manipal Hospital

Lupus is a health problem that affects people across the world irrespective of nationality, race, ethnicity, gender and age. It is common in the younger age group (more in women than men). With an objective to create awareness about this condition so that it can be diagnosed early and treated properly, World Lupus Day is observed every year on May 10th.

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To mark World Lupus Day, Biocon organised a guest lecture by Dr. Yogesh Singh, Consultant Rheumatologist at Manipal Hospital.

Here are few questions that Dr. Yogesh addressed during the lecture:

What is Lupus or SLE?

Lupus is a systemic autoimmune disease that occurs when your body’s immune system attacks your own tissues and organs like joints, skin, kidneys, blood cells, brain, heart & lungs. It is caused by a hyperactive immune system.

The immune system is the army of our body, protecting us by constantly fighting against disease-causing pathogens. It works in a very coordinated manner. The whole immune system is activated when it perceives a threat to the body. Once it has eliminated the threat, it shuts off. There are signals that say, “Cease fire”. The process is regulated so that inflammation does not become too much and conditions return back to normal. When the immune system does not shut off then one is said to be suffering from an autoimmune disease.

The most common Signs & Symptoms of Lupus are:

  1. Fatigue
  2. Fever
  3. Joint Pain, Stiffness & Swelling
  4. Butterfly shaped-rash on the face
  5. Skin lesions that appear or worsen with sun exposure (photosensitivity)
  6. Chest pain
  7. Dry eyes
  8. Headaches, Confusion & Memory Loss

What happens to the immune system in autoimmune disease?

When the immune system becomes hyperactive, they start attacking the body’s own cells. In normal circumstance, the immune mechanism can differentiate “self” from “non-self” cells and attacks the “non-self” cells. A hyperactive immune system loses the distinction between “self” and “non-self” cells and starts attacking the body’s own cells. (Good guys attacking the good guys, it’s like civil war going on inside the body). That is why a hyperactive immune system is not good, it should always be working optimally.

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What is the occurrence of Lupus globally and who generally is more susceptible to Lupus?

Worldwide, about 5 million people suffer from Lupus. Compared to the world population, it is a small number but still it is not an uncommon disease. It can affect anybody, irrespective of their nationality and race. It can also affect people from across age groups, from children to the elderly. There is however a subset of people that get it more often than others. That is females in the age group of 15 to 25. 80 per cent of population that get affected with Lupus are in the age group of 15-45. Rest would be either younger or older than that. So predominantly it is a woman’s disease.

Why are women more affected by Lupus than men?

Generally, a woman’s immune system is slightly more hyperactive as her body is exposed to more stress than men. In fact, a combination of genetic and hormonal factors are responsible for the high incidence of Lupus in women.

Which are the major organs affected Lupus and what are the general causes of Lupus?

Lupus can affect any organ. You can have skin rashes, especially on the face (hence the butterfly symbol from the butterfly shape). It is quite common, more so in Caucasian population. Rash can affect any part of the body, in addition to the face. Other common symptoms are joint pains. It can also affect the nervous system, cause seizures. Dry eyes and oral ulcers are common symptoms of lupus. It also affects the blood system, leading to low platelets count, anaemia etc.

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The brain, the skin, the eyes, the joints, the kidneys, the muscles, virtually any part of the body can be affected. It doesn’t mean that everyone will get everything. It is usually a combination of things. But some symptoms are more common than others. Symptoms are variable, each person will have a different subset of symptoms than others. Again, it is a multisystem disease. In routine clinical practice what we have typically observed is that while some get milder versions of the disease, it can be severe in others. Lupus is a spectrum disease, with a spectrum of conditions.

While the causes of Lupus remain unknown, three factors may play a role: Heredity, Hormones and Environmental Factors.

Environmental Factors include:

  1. UV rays from the sun which can activate inflammatory cells in skin
  2. Certain medicines, infections and stress might play role in triggering the diseases in some people.

However, Lupus is not contagious.

How can Lupus be diagnosed?

There is no single test to diagnose Lupus, and it’s often mistaken for other diseases. So it may take months or years for a doctor to diagnose it. Diagnosing lupus is extremely difficult because of its variable presentation. Similar things can happen in a lot of infections, allergies. Symptoms may start slowly. There is no gold standard test available for lupus. There is no diagnostic test for lupus. Diagnosis is basically based on the symptoms that you can see. So doctors look for multi symptom involvement. A particular test helpful in diagnosis of lupus is an anti-nuclear antibody (ANA) test. However, a positive ANA test does not necessarily mean a person has lupus.

What is the treatment for Lupus?

Treatment for Lupus is long term, like for diabetes and blood pressure. What doctors prescribe depends on the organ system involvement. One important thing to remember is than even if a person is doing well, it doesn’t mean that he or she should be off medication. He or she is doing well because of the medication. So do not stop your medication. Medical and non-medical management are both important.

How to lead a life with Lupus?

Although there is no cure for Lupus, early diagnosis and proper medical treatment can significantly help a person manage the disease. The best treatment approach is with a healthcare team that will tailor treatment to a specific condition. People have to balance their lives while living with a chronic illness. Maintain a healthy diet, get plenty of rest, avoid stress and exposure to the sun and UV light and stop smoking.

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