Lupus, the disease that attacks its own

The autoimmune disease is nine times more common in women than men.

In Summary

• The commonest manifestations appear on the skin and mouth.

• Genetics, environment, hormones and certain medicines are linked to the disease.

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Lupus is an autoimmune disease that occurs when the body's defence system produces antibodies that attack your own tissues, causing inflammation as opposed to the immune system protecting the body from infections.

Statistics show the disease is nine times as common in women as in men and more prevalent in younger people. Only about one in 15 cases begin after the age of 50 and tend to be less severe. In rare cases, lupus can affect children before the age of five.

The causes are not directly known. However, doctors link it to genetics, environment, hormones and certain medicines. It is not directly passed on from a parent to their children, but if you have a close relative with lupus, you are at an increased risk of developing the condition. Similarly, if you have lupus, there is about a possibility of your child developing it later in life.

Joint and muscle pain is often the first sign of lupus especially in the small joints of the hands and feet. The pain tends to move from joint to joint though it does not usually cause any permanent damage or deformation of joints. About one in 20 people with lupus develop more severe joint problems.

The commonest manifestations appear on the skin and mouth. A rash normally develops over parts of the body that are exposed to the sun including the face, wrists and hands. A butterfly-shaped rash over the cheeks and the bridge of the nose is especially most visible. You may develop groups of mouth ulcers, which may recur.

Cold weather creates an unsuitable environment for people with this disease as it results in their fingers changing colour from pale to blue and finally red. This is called Raynaud's phenomenon, which is due to narrowing of the blood vessels causing a reduction in the blood supply to the fingers, or toes.

The inflammation may affect different body systems including your joints, skin, kidneys, blood cells, brain, heart and lungs. The majority of patients present one, or a few of the possible symptoms, which are mostly inconsistent.

Around one in three people with the disease have a significant inflammation of the kidneys, which may cause kidney damage. This can be treated successfully in most patients once identified at an early stage through regular urine, blood pressure and blood testing conducted by a doctor. Medication will be prescribed to prevent permanent damage.

Occasionally, lupus directly affects the heart and lungs causing inflammation in the lining tissues around the heart and lungs, both of which cause breathlessness and sharp pains in the chest. In very few cases large amounts of fluid develop in these lining layers causing severe breathing difficulty.

The treatment administered to a patient with lupus will depend on the severity of the disease and the affected body parts. The medication will probably be adjusted as symptoms flare up, or improve as per the doctor’s assessment.

Dr Otieno and Dr Migowa are consultant rheumatologists at Aga Khan University Hospital

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