The antibodies made by the immune system normally protect the body against foreign invaders like viruses and bacteria. In certain autoimmune conditions, the immune system fails to differentiate between foreign substances and its own cells and tissues, and starts producing antibodies against the body tissues.

Systemic lupus erythematosuis (SLE) or Lupus as it is commonly known, is one such autoimmune disease. The ‘auto-antibodies’, cause inflammation, pain and damage in various parts of the body, mainly affecting the skin, kidneys, nervous system and blood cells.

Dr Akhilesh Sharma, Senior Consulting Physician Bombay Hospital says, “There is genetic susceptibility leading to the formation of antibodies, against certain proteins in the cell nucleus antigens. The antigenic stimulus appears to be due to some environmental insult. Lupus is more common in females. Estrogen a female hormone activates the immune cells called B and T cells.”

Symptoms

Lupus has a variable course with periods of exacerbation and remissions. Dr Sharma elaborates the typical symptoms or signs of SLE:

“The disease presents commonly with skin rash that is more prominent over sun exposed parts. The ultraviolet rays in the sunlight affect the skin cells. The reddish-violet rash over the cheekbones is called malar flush.

Kidneys are the other organ commonly affected by lupus. Kidney involvement in lupus signifies more advanced disease. This usually results in loss of proteins in urine due to abnormal filtering mechanism in the kidneys. This sometimes leads to swelling over the feet and face.

Lupus also causes joint pains as in rheumatoid arthritis. Similarly it can affect the red, white cells and platelets in the blood. It can affect the blood clotting mechanism leading to blood clotting in legs and brain.”

Lupus can cause epileptic symptoms and neuropsychiatric symptoms. Lupus also affects the stomach and liver. Due to its effect on small blood vessels it can cause dryness and redness of the eyes.”

Diagnosis

Diagnosis of Lupus is made by reviewing an individual’s medical history, current symptoms and results of routine laboratory tests and some specialised tests related to immune status.

Dr Sharma says, “To reach a diagnosis of SLE, clinical evidence of abnormalities in several different organ systems should be present. The disease is usually diagnosed by presence of antibodies against the nuclear proteins in the blood.”

In 1982, the American College of Rheumatology (ACR) issued a list of 11 symptoms or signs that help distinguish lupus from other diseases. While a person should have four or more of these symptoms to suspect lupus; the symptoms do not all have to occur at the same time.

The eleven criteria used for the diagnosis of Lupus are:

• Malar rash (rash over the cheeks)
• Discoid rash (red raised patches)
• Photosensitivity (reaction to sunlight, resulting in the development of or increase in skin rash)
• Ulcers in the nose or mouth (usually painless)
• Arthritis involving two or more peripheral joints in which the bones around the joints do not become destroyed
• Pleuritis or pericarditis (inflammation of the lining of the lung or heart)
• Excessive protein in the urine (greater than 0.5 gm/day or 3+ on test sticks) and/or cellular casts (abnormal elements the urine, derived from red and/or white cells and/or kidney tubule cells)
• Convulsions and/or psychosis in the absence of drugs or metabolic disturbances, which are known to cause such effects
• Hemolytic anaemia or leukopenia (white blood count below 4,000 cells per cubic millimeter) or lymphopenia (less than 1,500 lymphocytes per cubic millimeter) or thrombocytopenia (less than 100,000 platelets per cubic millimeter). The leukopenia and lymphopenia must be detected on two or more occasions. The thrombocytopenia must be detected in the absence of drugs known to induce it.
• Positive test for antinuclear antibodies (ANA) in the absence of drugs known to induce it. 
• Positive anti-double stranded anti-DNA test, positive anti-Sm test, positive antiphospholipid antibody such as anticardiolipin, or false positive syphilis test (VDRL).

Individuals suffering from lupus can maintain a high quality of life by developing an understanding of the disease and its impact. Learn to recognise the warning signs of a flare and learn to prevent them. Regular health care is important.

Treatment

The treatment for lupus is quite effective and has to be tailored for an individual. It usually involves steroids to suppress the heightened autoimmune response, corticosteroid cream for rash, nonsteroidal anti-inflammatory drugs (NSAIDS) for mild joint or muscle pain and fever, antimalarial medicines to treat fatigue, joint pain, skin rashes, and lung inflammation and at times medicines that slow down the immune system.

The other things that can help are:

• Rest to reduce stress.
• Avoid the sun. When going out wear sunscreen and protective clothing.
• Regular exercise prevents fatigue and joint stiffness.
• Stop smoking.

Help family and friends understand limitations and needs when symptoms flare. Develop a support system of family, friends, and health professionals.

Pic: wikipedia.org