June 14, 2023
“Make Lupus Visible”, was the theme of this year’s World Lupus Day, celebrated on 10th May. The intention was to create awareness of Lupus, and its social, psychological and economic impacts. Social media platforms such as this, certainly help us promote understanding of this fascinating condition.
No two patients with lupus are alike. Each patient’s journey is different depending on their age, gender, genetics, access to healthcare, social support system and other co-existing medical conditions.
Lupus develops when the immune system starts targeting the body’s own tissues/organs. This is called auto-immunity. Something has to trigger this process, and often these triggers are sun exposure, stress, infections, as well as vaccines and smoking. Occasionally certain drugs can induce lupus.
Lupus is known to be the “Great Pretender”. The symptoms can be so vague and can come and go at random intervals. Most commonly, fatigue, skin rashes and joint pain are the presenting features. There may be increased susceptibility to infections or easy bruising. Sometimes, when the lining of the lungs or heart are inflamed, chest pain on deep inspiration may develop. If the kidneys are affected, one may notice reduced urine output or ankle swelling. Less commonly, when the nervous system is affected, seizures or neuropathies may occur.
Patients will often present to their general practitioner with these symptoms, and it is generally following auto-immune testing on a blood sample, that a Rheumatologist is consulted.
Make a list of your symptoms and their date of onset.
Note the names of any medication you may have been prescribed for these symptoms and list the names and doses of other chronic medication that is being taken, including any contraception.
Ask your next of kin about the family history of medical conditions. Focus on first-and second-degree relatives.
A referral letter from your family doctor does help us, by providing a summary of your medical history.
Provide us with at least the name of the laboratory that processed your blood tests.
We will go through your symptoms, and medical history. When we examine you, we are very specific as to what we are looking for e.g. skin redness over the cheeks is different from the skin inflammation of a butterfly rash; joint tenderness is different from joint inflammation. Thereafter, an interpretation of the lab results will be given. We will then go through the criteria for lupus, and further tests may be requested, to clarify the diagnosis further. If treatment is commenced, the choice of therapy is dependent on the specific criteria which a patient has. Your Rheumatologist will go through the side effect profile, and how to take the medication.
On the other hand, should your Rheumatologist feel there are insufficient criteria to make the diagnosis of lupus, then alternative causes for your symptoms may be sought. Or, an approach of watchful waiting may be taken. The latter may entail a repeat of certain blood tests after 4 to 6 months, and a follow-up appointment.
Lupus patients have the same ability to fall pregnant as women in the general population. It is advised that the lupus must be in remission for a minimum of 6 to 12 months, prior to conception. So, talk to your specialist should you wish to fall pregnant, to get the timing right.
The outcome of treatment for lupus has improved greatly over time. To achieve this, patients are consistent with their medication, laboratory testing and specialist appointments. Should new symptoms develop, these are reported to the Rheumatologist, and treatment adjusted appropriately.
If you have been diagnosed with lupus, it will be a part of you, but do not let it define you.
Set the trend, that by leading a healthy lifestyle, and being regular with medical therapy, Lupus can be conquered!
Dr Amritha Budhoo
Specialist Rheumatologist & Physician
Busamed Gateway Private Hospital, Umhlanga
November 22, 2023
November 2, 2023