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The
Diseases of
Many FacesOct
2014

Name for the wolf because the disease is said to cause scarring rashes that look like wolf bites or because it devours affected parts, the many meanings of lupus are surpassed by its many disguises.

There’s no single way to diagnose systemic lupus erythematosus (SLE) or lupus. Th e disease of many faces affects the skin, joints, kidneys, haematological system, lungs, blood vessels, brain, gastrointestinal tract, heart and more. Diagnosis is based on a range of criteria such as blood tests for auto-antibodies, cell counts and kidney function, as well as tissue biopsies of the aff ected organ.

The Enemy From Within

At its core, SLE is an autoimmune disease, meaning that the body’s immune cells attack its own healthy tissues, leading to infl ammation and tissue damage. If not suppressed, this causes a range of complications over time, including:

Kidney Damage: Up to three out of four people with lupus can develop kidney problems.

Heart Problems: Lupus can cause inflammation of the sac around the heart and increase the risk of arterynarrowing plaque.

Lung Inflammation: Some people with lupus may suffer from this, leading to painful breathing, chest pain, cough and breathlessness.

Digestive Problems: Though uncommon, lupus can cause belly pain, nausea, vomiting, difficulty swallowing, or inflammation of the liver or pancreas.

Anaemia and Blood Cell Problems: Lupus can affect the red blood cells, white blood cells and platelets, and the medications used to treat it can contribute to anaemia and abnormal blood cell counts in some patients.

Nervous System Disorders: Lupus can trigger a wide range of nervous system issues such as headache or mild memory problems. Some people with lupus have a greater risk of stroke, and in rare cases, seizures.

Mental Health Concerns: Depression and anxiety are a risk and may be the result of the condition's effect on the nervous system or due to the emotional strain of coping with a chronic illness.

Pregnancy Complications: The condition increases the risk of complications during pregnancy. Speak with your rheumatologist to discuss the best time to conceive and to modify the medications prior to conceiving.

Risk Factors and Symptoms

SLE is estimated to affect 0.5% of the population and tends to be more severe with people of Oriental and Afro-Caribbean origin. It affects women 10 times more often than men. Aside from being female, your odds of getting the disease are higher if you are:

  • of African-American, Latino or Asian descent
  • aged between 20 and 40
  • from a family with a history of lupus

There are many manifestations of SLE:

Joint Pain: Joint and muscle pain, particularly in the joints of the wrists, hands, fingers, and knees, are often the first signs of lupus. The joints may look inflamed and feel warm to the touch. Unlike rheumatoid arthritis, lupus usually does not cause permanent joint damage.

Butterfly Rash: A distinct sign of lupus is a butterfly-shaped rash across the cheeks and bridge of the nose. Other skin problems include sensitivity to the sun with flaky, red spots or a scaly, purple rash on the body, face, neck and arms. Some people develop mouth sores.

Fever and Fatigue: Lupus causes some degree of fatigue severe enough to interfere with daily activities. Most patients also run a low-grade fever from time to time, which may be the only warning sign in some people.

Light Sensitivity: Lupus causes unusual sensitivity to the sun and other forms of ultraviolet light causing skin rash.

Hair Loss: Hair may fall out in patches or become thinner. Post-flare up, new hair tends to grow back.

Raynaud's Phenomenon: Painful, numb, and tingly fingers and toes triggered by cold temperatures or emotional stress. This happens when small blood vessels spasm and restrict blood flow, causing the affected parts to turn red, blue and white at the same time.

Living With Lupus While there is no cure, the condition can be managed. People with severe lupus may benefit from immune-suppressant drugs that restrain the mutinous immune system. Doctors are now able to better balance disease control with the side eff ects of treatment. Lifestyle changes are also important. These include adequate sun protection, avoidance of smoking, regular exercise, a healthy diet, stress management and plenty of rest. Some people with lupus need up to 12 hours of sleep a night. This multi-modal approach has helped people with lupus live significantly longer and healthier lives.

About Our Arthritis Specialist

A/Prof Leong Keng Hong is a senior consultant Rheumatologist at Gleneagles Medical Centre and Adjunct Associate Professor, Yong Yoo Lin School of Medicine, National University of Singapore. He founded the Osteoporosis Society (Singapore) in 1996 and served as its President until 2004. He was also the Inaugural Chairman of the Chapter of Rheumatologists, College of Physicians, Academy of Medicine, Singapore from 2004-2007 and its current Chairman until 2013.

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