MICHELLE'S BODY was changing. She had the classical moon-shaped face as a result of the steroids she was given for her lupus, and her once slim figure is now fat. She said even her close friends, did not immediately recognise her. She felt depressed, but the dark cloud hanging over her soon moved when she learnt more about the disease and joined a support group.
Dr. Karel Deceulaer, rheumatologist said lupus is an auto-immune disease, that is, it is a disease of the immune system. The immune system is a network of body cells that protects the body against infectious agents, both external factors such as germs and dysfunctional cells of the internal system.
"In lupus the immune system actually overreacts. It reacts against its own cells and do damage to them and the symptoms of lupus are related to the fact that the immune system is acting against a particular system," Dr. Deceulaer said.
The symptoms experienced by patients are variable. If the immune system is acting against the skin, for example, the patient might develop skin rashes; if the brain is affected the patient might have fits and other organs such as the liver and kidneys can also be affected. Though the symptoms are variable depending on the system affected by the immune system, he said the core symptoms are joint pains and skin rashes. In fact, he said if a young woman (20 to 35 years) develops unexplained skin rashes and complains of joint pains, it is reasonable for the physician to suspect lupus.
Dr. Deceulaer said the lupus patients who develop kidney disease are most seriously affected.
"If the patient does not have kidney disease, they are much better off. If there is kidney disease, the nephrologist will do a kidney biopsy. Some kidney diseases are very aggressive and have to be treated aggressively," he said.
If the doctor suspects lupus, then the patient is asked to do the blood screening test - the antinuclear antibody (ANA) test.
"This test is positive in 95 per cent of lupus patients but in the early stages of the disease the test might be negative, so the doctor would want to have this test done four to six months into the disease. A positive test could mean rheumatoid arthritis and other diseases; some people can inherit positive tests without having the disease. So we also do an anti-DNA test if the results are positive. Normal people do not show positive anti-DNA tests, so if that test is positive, we know for sure that the patient has lupus," Dr. Deceulaer said.
The treatment
If the kidneys are not affected then medication is normally given to reduce inflammation. Some-times, Dr. Deceulaer said, that even if kidneys are not affected, steroids might be given in low doses. If kidneys are involved the patient is given high doses of steroids with or without immuno-suppressive drugs. With this aggressive regime, the patient has to visit her doctor regularly and have regular blood and urine tests.
"These are heavy medications but the kidneys are at stake and if the patient doesn't take them she won't live long.
"Steroids reduce the inflammation of lupus and is the best anti-inflammatory drug. The body also makes steroids naturally, so because it is a natural product it works well but in high doses it has side effects such as weight gain, induced diabetes, high blood pressure, skin thinning and osteoporosis," he said.
Eulalee Thompson
