Systemic Lupus Erythematosus (SLE): Symptoms, Diagnose and Treatment – Dr. Keerthi Talari

Systemic Lupus Erythematosus, generally called Lupus is an autoimmune disease. When we say autoimmune disease, it means that our immunity is attacking our own body. Normally, immunity is our resistance power. It is a power to fight against any infections that are affecting our own body, and it is usually protective for one’s body. But certain times, this immunity can attack their own self, and that is when it is called autoimmunity. Lupus is one of the most important autoimmune diseases, which commonly affects women between 15-40 years of age compared to men. Hence, very young women can get affected with this disease. But no age is an exception. There are chances that elderly people may develop this disease. As this is an autoimmune disease, it can affect different parts of the body.

Most of the time the disease affects your skin, joints, or the blood counts presenting skin rashes, especially over the cheeks and the nasal bridge. On exposure to the sun, rashes can occur on any part of the body along with heavy hair loss, ulcers in the mouth & nose are other common symptoms. There can also be joint pains and joint swellings, with a lot of stiffness in the early morning in some individuals. And certain people may present with a decrease in blood count, which can start all of a sudden and does not respond to common medications like iron tablets or vitamin supplements leading to low haemoglobin. The WBC count & platelet count might become low despite giving blood transfusions or platelet transfusions. The counts may not improve as the immunity may damage their blood cells. This is the most common presentation, but along with this, the people can present with kidney problems (50% of them can have protein loss through their kidney). It does not mean that their kidney is damaged. It just means that their kidney is losing more protein. 

If the disease is diagnosed at an early stage, it is possible to completely control this problem and regain the kidney function to normal. 30% of them can have problems in the muscles, heart, or the lungs presenting symptoms such as shortness of breath intermittently or while walking, or chest pain to one side of the chest or they can have central chest pain, and intestinal problems. They can have problems with their nerves or their brain. Basically, lupus can affect any organ, and for the first time, it may present any different symptoms. Most of the time, patients with lupus do not consult a rheumatologist initially. They have symptoms, but it can pertain to any particular organ. For example, they initially have only a skin rash. Then they may meet a dermatologist. Or if they have chest pain, or if they are experiencing breathlessness, they might meet a cardiologist. The role of a rheumatologist in lupus is that first, they confirm that this is lupus by examining the symptoms, blood investigation reports, and performing certain tests that are very specific to lupus i.e. Antinuclear Antibody (ANA).

Based on the symptoms, diagnosis of lupus is made and after the diagnosis, the organs are getting affected because you may have only joint pain, but you may actually have an internal organ involvement like a kidney. So, some tests are performed to find out which other organ is involved and treatment is given accordingly. In lupus, steroids are given in the initial phases at higher doses. Normally, for a common man, steroids are not good for their health because they actually decrease their immunity. But in lupus, immunity is affecting their own body; it is immunity which is at fault, so to control this steroids administration becomes very important in the initial treatment of lupus. In the long term, it is not advisable to continue very high doses of steroids.

Steroids are given at very low doses which do not cause any harm to the individual. Since the disease should not be progressed as the steroid dose is decreased, some steroid sparing agents are given, which has the same effects as that of steroids. They do not have the major side effects that steroids usually have. These steroid sparing agents are very helpful in lupus in controlling the disease for long-term and also in improving the survival of the patient. Usually, people who have lupus can have a mild disease where they may have only skin or joint involvement, or a minimal decrease in their blood count, or they may even have a severe disease where their kidneys and nerves are getting affected.

Depending on the severity of the disease, the treatment for the individual person can change. There could be people who are only given low doses of steroids, people who are given very high doses of steroids, people who are given steroid sparing agents, immunosuppressants which are mild, or severe. This depends on the stage of the disease, and treatment can vary. The disease can be in treatable phase if detected initially. 

If the kidney gets affected and left untreated in the long term, it may damage the organ and there could be an increase in creatinine. The patient may have to be on dialysis, or may have to undergo a renal transplant. Lupus is not a very small disease to have. There could be a lot of complications even in people who are very regular with treatment. There could be flares in particular situations like whenever the doses are suddenly decreased, or medication is not taken for a few days, or an individual is going through a stressful situation wherein the disease may suddenly increase, and it may become very difficult at times to control the disease and make it completely normal. It has been known that people who have lupus, out of every 100 patients, only 90 of them would survive at the end of five years. 

Basically, the patient should have regular follow-up with constant monitoring and treatment as advised and keeping us regularly informed about any new symptoms that they develop. In the initial few years, the doctor may ask the patient to come for monthly or a bimonthly follow-up. Once the disease is completely under control, then the patient is advised to visit for follow-up every 3-6 months and then prescribe the medications accordingly. Certain patients with lupus who are well under control may have to continue just 1-2 medications. The precautions that a patient should take is to avoid UV rays which have been found to increase lupus. They increase the production of ANA within the body and can worsen the disease. A patient with lupus should not get exposed to sunlight especially between 10 am to 4 pm. Even if they have to get exposed, due to some reasons, it is better that they use sunscreens, hats or umbrellas to avoid direct exposure to the sun. Practice a very healthy lifestyle i.e. 30 minutes of exercise per day along with a good balanced diet eating a lot of green leafy vegetables, fruits, taking a lot of milk and milk products, and avoiding a lot of oily stuff and junk food. Patients should protect themselves from infection as much as possible.

Personal and hygiene at home is something that is very important. And avoiding overcrowded places where an individual can easily catch an infection is one more thing. They should be doing so because the immunity is not functioning very well and also the patient will be under immunosuppressants which can further decrease the immunity, so developing infections is something that is very commonly seen in patients with lupus. 

Another thing that a lot of people have a doubt about is, most of these lupus patients are very young; they are between 15-30 years of age. An age where they get married, they may have to plan a family, and they will have to handle their kids after that. So a lot of parents and patients with lupus or their husbands keep asking whether they can lead a normal life, whether they can plan a pregnancy in the future or will their child have any problems. First thing is that if a patient has lupus, it is under complete control, and a pregnancy can be planned and can have a completely normal baby with absolutely no problems or complications. The outcomes of pregnancies in lupus are as much as that of a normal pregnancy, but with the clause that lupus should be completely under control. Lupus is not something that will spread to the baby post-delivery and there is nothing to be worried about.

Definitely, a patient with lupus can plan pregnancy whenever your Rheumatologist says the disease is completely under control. During pregnancy, the patient may require more follow-ups, monitoring compared to any other normal person. Considering that lupus is such a vast disease with so many manifestations, if you have lupus, you should be meeting a rheumatologist to find out which organs are affected, how severe is your lupus, and the treatment needs to be adjusted by them accordingly. For patients with lupus, we run a lupus clinic at Yashoda Hospital, Secunderabad every Wednesday between 9 am – 12 pm. Patients who have a suspicion or have a doubt of having lupus, or who have already been diagnosed with lupus and want to know more about their disease, or want to know how severe their disease is and how their medication needs to be adjusted, or what medications need to be taken, who need counselling for both them or their family members can visit this clinic, which is an exclusive lupus clinic on every Wednesday.