What we should know about lupus: a multisystem disease


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Systemic Lupus Erythematosus, is a disease of autoimmune origin, that is, by means of antibodies, the body attacks itself, chronic, inflammatory, and worth the redundancy, multisystemic, therefore it can affect each and every one of the organs of the human body. And in fact, due to its high complexity, it is considered one of the most studied diseases in Medicine.

MANIFESTATIONS OF LUPUS:

Because Lupus can affect any organ, its manifestations are quite flowery. The main ones range from the constitutional ones, that is, fever, fatigue, malaise, anorexia and weight loss. The skin is also frequently affected, with several subtypes of Cutaneous Lupus, some being more specific than others, within the acute lesions, there is the malar rash or “butterfly wings”, chronic lesions such as discoid lupus, which tends to leave scars, and other subacute injuries, which can be seen on the hands, neckline, arms.

There are musculoskeletal manifestations, where tendons, muscles, bone and joints can be affected. These range from arthralgia (joint pain) to arthritis (joint pain and inflammation) that can become disfiguring and extremely disabling.

Kidney disease is one of the most fearsome manifestations within systemic lupus erythematosus, since it is the main cause of morbidity and mortality. It affects up to 50-60% of patients and is characterized by glomerular damage. The patient may present edema of the lower limbs, high blood pressure, foamy urine and, in laboratory tests, proteinuria, urinary sediment, increased cretinin.

Other manifestations are neuropsychiatric, also called Neurolupus, seen in less than 5% of patients, and 19 different entities have been described, some are cognitive dysfunction, neuropathies, cerebrovascular events, migraine, among others.

Other systems such as the gastrointestinal, with mesenteric vasculitis, pancreatitis. Cardiopulmonary, with endocarditis, pericarditis, pericardial effusion, arterial hypertension and also develop accelerated atherosclerosis, in terms of hematology at least 50% of patients during their disease develop anemia, however the presence of lymphadenopathy, lymphopenia and thrombocytopenia is also frequent .

AT WHAT AGE CAN YOU SUFFER FROM THIS DISEASE OR CAN YOU BE BORN WITH IT?

Systemic lupus erythematosus can appear at any age, however it is more frequent between 15 and 40 years of age, in the most productive stage. It predominates in women with a ratio of 9:1, decreasing after menopause.

The condition or clinical profile of patients can be influenced by the age at which symptoms appear, with greater aggressiveness in patients where they start at an early age.

Being born with Lupus is rare, and there are several factors that influence it. I imagine that it refers to the so-called Neonatal Lupus, it is an infrequent autoimmune entity, in this there is a passage of maternal antibodies via the placenta and this can happen in children of mothers with Lupus. It also affects multiple organs, such as the heart, producing congenital heart block, also affects the kidneys, skin and blood.

WHICH PATIENTS ARE MOST LIKELY TO SUFFER FROM THIS DISEASE?

Systemic lupus erythematosus is found throughout the world, it is more frequent in the United States and Europe, being rare in Africa, however, a high prevalence is described among Afro-descendants in the Caribbean and the rest of Latin America, where its appearance is earlier and its behavior is more severe with a great presence of lupus nephritis.

The economic and social conditions, which predispose to little access to health and a decent life, influence not only its clinical presentation, but also its prognosis.

AT THE TIME OF DIAGNOSIS, WHAT SHOULD THE PATIENT’S DAILY LIVING BE LIKE?

The main thing in the patient with Lupus or any other autoimmune disease is the acceptance of their disease, followed by education. A Lupus patient is an ordinary person, who has been presented with a test in life. Living with lupus can be difficult emotionally and physically. He is a person who must learn to live with multiple conditions, one day he can feel very bad and the next he can be great. Attitude and perception greatly affect the patient’s prognosis.

In addition to that, you must learn to manage the disease together with your rheumatologist, attend your appointments, learn to use your medications, keep a record of your symptoms, detect the signs that something is serious.

WHICH SPECIALISTS INTERVENE IN PATIENT MONITORING?

The main specialist who is prepared for the diagnosis and treatment and who must follow up is the rheumatologist, because it is a multisystemic disease, we join the other specialties, such as nephrology, dermatology, psychiatry, among others.

CAN IT BE SAID THAT WHEN A PATIENT IS DIAGNOSED WITH THIS DISEASE SHOULD TAKE A SERIES OF SPECIAL CARE?

It depends on the degree of severity with which the disease occurs. The Lupus patient is a warrior by nature, he will always look for a way to deal with the manifestations of his disease. That does not mean that at some point he needs help, be it to get dressed during an episode of arthritis, or to move around, if he has a lot of fatigue or some manifestation of the nervous system. But usually, the lupus patient is very independent.

CAN LUPUS BE CATALOGED AS EXTREMELY DANGEROUS TO THE LIFE OF THE PATIENT?

Yes, since, as I had previously mentioned, it is a chronic disease that involves a high rate of morbidity and mortality due to several factors, such as, for example, the age of presentation, cumulative damage, cardiovascular risk, among other factors.

The most important thing is to be diagnosed and treated on time, since currently the survival of patients with lupus exceeds 90%.

CAN A PERSON HAVE LUPUS WITHOUT KNOWING IT?

Of course, although we are in the era of “self-diagnosis” thanks to Google, there are still many patients who do not seek help and others who go to endless consultations looking for a solution, without any improvement.
Let’s remember that lupus is also called the “Great Simulator”, since it can camouflage itself, look like any disease. The correct thing is that if you present symptoms like the ones we discussed, seek help and attend a consultation with your rheumatologist.

TREATMENT FOR PATIENTS WITH LUPUS:

We currently have an arsenal of treatments for patients with systemic lupus erythematosus, ranging from changes in lifestyle, education, which is essential, immunomodulatory drugs such as antimalarials, glucocorticoids, methotrexate, azathioprine, mycophenolate mofetil, to therapies biological, which depending on the patient’s profile, will be used for the different manifestations.

The main objective is to keep the disease inactive, prevent a large accumulation of organ damage with the lowest possible dose of drugs.

CAN LUPUS BE PREVENTED?

Systemic lupus erythematosus cannot be prevented, since it is not possible to determine who will develop lupus and who will not.

RECOMMENDATIONS:

But activities can be carried out to try to reduce the probability of outbreaks or increased activity of the disease in patients, such as a balanced diet, limiting exposure to the sun, reducing the use of alcohol and cigarettes, stress management, exercise.

Dr. Jennifer Santana Peralta,
Rheumatologist – Internist
Graduated from the Padre Billini Teaching Hospital.
Specialist in procedures such as capillaroscopy, skin and muscle biopsies, minor salivary glands, Vista del Jardín Medical Center

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