What about Lupus?

Posted on Feb 08, 2018

Every first week of February is celebrated as the ‘Lupus Advocacy Week’, declared by the Presidential Proclamation 1435. The celebration aims to raise awareness and spread information on lupus, in order to ensure that no life is threatened by the lack of knowledge or misinformation.

This condition has long been considered a great mimic of many disease entities, and has become an enigma to many clinicians for its vague presentation. What really is lupus?

Our body has a natural defense mechanism, commonly known as the immune system, which attacks foreign aggressors and hazards. The immune system protects us from germs and other microorganism, keeping us away from diseases. However, it is not without its flaws. In some circumstances, it wrongly attacks healthy cells and tissues in an effort to guard the body. This occurrence marks the presence of systemic lupus erythematosus (SLE) or lupus.

If you have lupus, your immune system works the other way around by harming you instead of protecting you. The hallmark of the disease is the production of autoantibodies such as the anti-nuclear antibody (ANA) and several lupus specific antibodies. It can attack one or certain body parts or organs, one body part or organ after another (sequentially), or several body parts or organs at the same time (simultaneously). Worse, it may lead to other complications and cause death.

Some of the most common targets for lupus are the joints, skin, kidneys, heart, lungs, blood vessels, central nervous system, and brain. While there is still no verifiable direct cause, this autoimmune disorder has been noted to be more common among the females, with nine out of ten patients belonging to this gender, especially those in the childbearing stage and those with familial genes. Several studies have revealed that between 20% to 40% of identical twins will have the genes for lupus, yet the greater number of lupus patients may have been caused by environmental triggers like the Epstein-Barr virus (EBV).

Everybody, therefore, should be on guard against lupus for it affects the young and the old. Many people with lupus have certain symptoms just before a flare, such as feeling more tired than normal, body pain, rash, fever, headache, loss of hair and oral sores. These symptoms are also common to other diseases, making lupus detection a challenge to doctors and patients alike. Differentiating the presence between an infection and a lupus flare is also difficult. Being a prototype systemic autoimmune disease, lupus can also overlap with other connective tissue diseases.

There are no specific figures about the prevalence of lupus in the country, mainly because it mimics other diseases and is either misdiagnosed or underdiagnosed. Range of organ involvement could be from just simply the skin (cutaneous lupus) to severe multi-organ dysfunction (i.e., lupus nephritis, lupus pericarditis and central nervous system lupus). Accurate and early detection and treatment is imperative so that the disease can be controlled, monitored, and worked up for remission.  Patients must understand that it is a chronic condition which requires lifelong medical attention of both the patient and their doctor.

There are certain clinical, laboratory, and immunologic criteria for the screening of lupus. There is no single screening test for lupus and it may take anytime from a few months or over a year for a doctor to diagnose it. Aside from getting your medical history, complete physical exams, specific blood tests, skin biopsies, kidney biopsies, and clinical criteria can help identify lupus patients.

Seeking an experienced clinician and a center with adequate facilities to perform all the necessary tests to identify lupus is ideal. Locally, St. Luke’s Medical Center performs comprehensive serologic tests such as the ANA indirect immunofluorescence titer and pattern, the lupus confirmatory panel, the lupus disease activity panel, and the antiphospholipid antibody panel among others. Being conscious of the fact that precision and accuracy are the imperatives of clinical diagnosis, the hospital ably assists doctors, and clinicians in the diagnosis, treatment and prognostication of diseases.

Once diagnosis is established, rheumatologists can refer back the patient to their primary caregiver for continuity of care if sustained remission is achieved. At times, SLE treatment requires a team approach that a tertiary referral center like St Luke’s can provide. Composed of highly skilled and well-trained medical and allied health specialists and led by rheumatologists, the team will develop a treatment plan to fit a patient’s unique needs. The medical group reviews the plan often to be sure it is working, and if applicable, take note of new symptoms right away so that treatment can be modified as needed. Having mentioned also the social aspect of the disease, St. Luke’s holds a quarterly forum that helps to ease the burden among patients suffering this chronic condition. The goals of the treatment plan are mainly to prevent flares and treat them when they occur, reduce organ damage, and prevent further complications.  A sustained remission of the disease is what the doctors should aim to achieve.

With the survival rate dramatically improving through the years, the key to successful management is early and accurate diagnosis, proper treatment, and close disease monitoring. Most people with lupus live long, productive and normal lives, in the hands of expert medical care and consistent disease management.