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When The Wolf Bites


Lupus - which means wolf in Latin - was so named because the disease causes a rash on the face which was thought in ancient times to resemble the bite of a wolf. It is an autoimmune disease which causes the immune system to develop antibodies that attack healthy tissue instead of fighting bacteria and viruses as they are supposed to. This mistaken immune response then leads to inflammation, which can spread from the initial site to other parts of the body.

It is not known what causes lupus. It is believed that some people are genetically predisposed to developing the disease, which is then triggered by factors such as hormones, viral infections, exposure to sunlight and certain drugs. Nine out of 10 lupus sufferers are women, so female hormones are suspected to be a possible trigger.

 The behavior of the disease is believed to depend on which among 20 or so genes associated with lupus are defective in a particular patient. In mild cases, lupus sometimes affects only the skin, causing a variety of rashes. But in severe cases, it can affect organs like the brain, heart, lungs and kidneys, causing inflammation, severe damage and sometimes even death if not treated in time.

Studies have shown that between 50 and 70 per cent of patients may have at least one internal organ affected, though again the severity may vary. The most common causes of death are organ failure caused by the disease and infection. Patients can succumb to infection when they are attacked by viruses and bacteria while being treated with high doses of immunosuppressive drugs to stop the immune system from attacking the organs.

Expert  said: the disease is very variable. If the patient suffers from the mild form of the disease, she can go untreated for some period of time and not have anything happen to her. But if those with the aggressive form are not treated, their mortality rate is very high. As far as possible, the disease should be diagnosed early, as it is not possible to predict for each individual how it will progress over time, or how aggressive it will be.

If patients are diagnosed early, doctors can monitor them, do regular tests to assess if the disease is flaring up and give medication early to prevent organ damage. There is no cure for lupus. Like asthma and other chronic diseases, it is treated with drugs to control and prevent it from flaring up and causing potentially life-threatening complications. 

And most patients can expect normal lifespans. Lupus patients have been known to live as long as 40 years after the diagnosis. Expert says that when the disease is active, it can be debilitating and patients feel very unwell. But the majority of patients go into remission with medication and live more or less normal lives. 

Symptoms

Lupus can cause a whole range of symptoms, many of which are not specific to the disease. Common tell-tale symptoms include a rash on the cheeks and bridge of the nose, often in the shape of a butterfly, rashes after exposure to sunlight or ultraviolet light, Raynaud's phenomenon - when fingers turn white or blue when cold ulcers inside the mouth or nose that persist longer than two weeks, seizures and anaemia.

The most common symptom tends to be joint pains or arthritis, said expert. However, patients may find it difficult - especially when they first wake up in the morning - to move the joints, which can be ache, swell or be very stiff due to inflammation. While some patients may find the rashes slightly itchy, most usually do not itch. The rashes get worse - more red and prominent- after the patients have been out in the sun.

Most patients are diagnosed when they start showing some suggestive symptoms, say, the rashes, or a prolonged fever that persists despite treatment. Once a doctor spots clinical signs, blood, urine and antibody tests are needed. One common test checks for the anti-nuclear antibody, the antibody that acts against the nuclei of cells. Most lupus sufferers will test positive. However, only 30 per cent of those who test positive have lupus.

Risk Factors

Women are at greater risk than men and are usually afflicted during their child-bearing years, between 15 and 44. Women in this age group are 10 to 15 times more likely than men to develop lupus. Lupus is also two to three times more common and more severe among Asians, Hispanics and African Americans as compared to Caucasians.

Treatments

Patients suffering from the mild form of the disease, with no internal organs affected, are usually given a non-steroidal anti-inflammatory drug (Nsaid) like aspirin to ease joint pains and aches. Alternatively, they may be given an anti-malarial drug, which can reduce joint swelling and pain as well as inflammation of the lung lining, skin rashes and fatigue.

Patients with more severe forms of the disease, with at least one major internal organ affected, will need to take steroids orally, and sometimes in very serious cases, even intravenously. The steroids are powerful drugs that suppress inflammation. They are used in a moderate to high dose for about two months, after which another type of immunosuppressive drug is added.

The additional immunosuppressive drug is introduced so that the dose of the steroids can be gradually cut to a low dose for long-term use without causing the disease to flare up again. Often, to keep the condition stable over the long term, such patients will take a combination of steroids, one other immunosuppressive drug and an anti-malarial drug. 

Doctors will try to reduce the dosage of the steroids to as low a dose as possible, or even cut it out altogether, as high doses pose problems when used over a prolonged period. These include excessive hair growth, increased weight, a puffy face, acne, and a higher risk of developing high blood pressure, diabetes and osteoporosis. The chances of suffering from such side effects differ from individual to individual. Some people develop problems after just one or two years, but others experience no issues after 10 years, expert said.

The Damage Lupus Can Wreak

Skin

A red rash in the shape of a butterfly across the cheeks and on the bridge of the nose, other rashes after exposure to sun, unexplained hair loss.

Heart And Lungs

Chest pain while taking deep breaths, prolonged inflammation that could lead to organ failure

Muscles And Joints

Inflammation, pain and stiffness 

Brain And Nervous System

Unexplained prolonged fever of more than 38 deg C, seizures, confusion.

Eyes, Nose And Mouth

Sores in nose and mouth or dryness in eyes and mouth for more than a week.

Kidneys

Nephritis, or kidney inflammation, which could, over time, lead to kidney failure.

Blood And Circulatory System

Anaemia, low platelet count, low white cell count, and fingers and toes become pale, numb and painful in the cold.

The Silent Disease

Experts sheds light on lupus... 

Who's Susceptible?

Lupus mostly strikes women of child-bearing age. Figures show it's more common in Asians, Hispanics and African-Americans.

What Are The Symptoms?

The cause of lupus remains undetermined. It can present in various ways, but the onset is gradual with symptoms like headache, fever and fatigue. More suggestive signs include rash on cheeks and bridge of nose; mouth ulcers; chest pain and rash after exposure to sunlight. With the symptoms differing among individuals, it is difficult to diagnose lupus.

How Does It Affect Sufferers?

Lupus can affect practically every organ. The antibodies produced by the body attacks healthy tissue instead of viruses and bacteria, leading to inflammation. A chronic disease, its effects last throughout life.

Is There A Cure?

No, but for most patients, it eventually goes into remission. Patients can undergo childbirth but some may be advised against it due to side effects of medication on the foetus.

 

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