Ladies, is your oestrogen level too high? Watch out for Lupus

By Dr Anil Kumar BT

Lupus is an autoimmune condition where the immune system — whose job is to fight foreign substances in the body such as bacteria and viruses — mistakenly attacks healthy tissues. Any system or organ can be affected, including joints, skin, kidneys, lungs, heart and brain.

Lupus can affect anyone. However, it is more common in women than in men, especially in the child-bearing age group (15-45 years). The reason for this gender difference is because of the possible association between sex chromosomes and sex hormones. Women with lupus have higher oestrogen levels. It is not known exactly what causes lupus. Lupus sometimes seems to run in families, which suggests that the disease may be hereditary. The environment, sunlight, stress and certain drugs may trigger symptoms in some people.


Types

The three main types of lupus are:

• Systemic lupus erythematosus (SLE): This condition is the most common form and is what most people mean when they refer to lupus. ‘Systemic’ means the disease can involve many parts of the body and any organ

• Discoid lupus erythematosus (DLE): Discoid lupus erythematosus is typically a milder type of lupus that usually only affects the skin

• Drug-induced lupus: More than 100 medications are known to cause lupus symptoms

Symptoms

Lupus patients may have many symptoms and these symptoms differ from person to person. However, the most common symptoms are:

• Joint pains

• Unexplained fever

• Prolonged or extreme fatigue

• Red ‘butterfly’ rash or colour change on

The cheeks

• Ankle swelling and fluid accumulation

Often there are periods of active illness called “flares” and periods of “remission” during which there are few symptoms.

The SLE type of lupus can lead to complications, including kidney failure (lupus nephritis) and cardiovascular disease such as heart disease and stroke.

People with SLE are also more likely to have another autoimmune condition including thyroid problems, Sjögren's syndrome and Hughes syndrome. SLE can be a concern in pregnancy as it may increase the risk of pre-eclampsia, miscarriage, stillbirth and premature birth.


Diagnosis

There is no single diagnostic test to confirm whether someone has lupus — doctors rely on a combination of tools including medical history, physical examination, blood tests, urine analysis and kidney biopsy. The American College of Rheumatology (ACR) has identified 11 criteria to help doctors diagnose lupus. A person should have at least four of the 11 criteria, either at the same time or one after the other, to be classified as having lupus.

Blood tests can detect the presence of antibodies associated with lupus. An antinuclear antibody (ANA) test is a sensitive screening tool to diagnose lupus. However, this test may be positive even in some healthy individuals.

Course of treatment

There is no known cure for lupus. The goal of treatment, instead, is to prevent flares, treat flares when they occur, and reduce organ problems and other complications. Doctors may prescribe medications to treat lupus directly as well as other conditions related to lupus; these include high cholesterol, high blood pressure and infection. Common medications include NSAIDS for relieving pain, corticosteroids, antimalarial drugs, immunosuppressants and biologicals.

Awareness helps

In short, lupus is a complex disease affecting women commonly and symptoms vary from person to person immensely. Awareness of the common symptoms helps in early diagnosis and preventing organ damage.


—The writer is Senior Consultant Nephrologist, BGS Gleneagles Global Hospitals, Bengaluru