Health

Lupus commonly mistaken for arthritis — Expert

Dr Ibukunoluwa Dedeke, a consultant rheumatologist at the University College Hospital, in this report by SADE OGUNTOLA says many cases of lupus are mistaken for flu, malaria and even arthritis; and that early detection and treatment is important to avoid its many complications.

What is lupus and how does a person get this condition?

Lupus is the short name for Systemic Lupus Erythematosus. It is a chronic systemic auto-immune disease resulting from the body’s immune system attacking it. It can attack any organ system in the body and often attacks two or more systems at the same time in the patient. The cause of lupus is unknown, but genetic and environmental factors have been implicated. Lupus is commoner in African-Americans, Afro-Caribbean and Hispanics more than Caucasians. It is about nine times more common in females than males, and often develops in women in childbearing age. Current research in Africa has shown that it is not as rare as people used to think. Some environmental factors that have been implicated include ultraviolet light, drugs, cosmetic products, as well as infectious and endogenous viruses.

What happens to an individual with lupus?

The symptoms of lupus are protean, and is determined by the parts of the body that is affected. It may start with low fever with unexplained fatigue, joint aches and muscle aches, which often times is mistaken for malaria or typhoid. Because of this, many of our lupus patients would have been treated severally for malaria and typhoid before diagnosis. Some common early symptoms of lupus include also persistent or recurrent rash over any part of the body but commonly over the cheek and bridge of the nose, which may worsen with exposure to the sun; recurrent mouth ulcers that are often painless; progressive hair loss, multiple joint pain with joint swelling; chest pain worse with breathing; and passage of frothy (foamy) urine.

Are there specific parts of the body that are affected?

Lupus can affect any organ system in the body. It commonly affects the skin and mucosa, joints (hands, wrist, shoulder, knees, ankle, hip), the kidneys, the lungs, the heart, and the nervous system (brain, spinal cord and nerves). The early symptom of kidney involvement is passage of frothy urine, but lupus can damage the kidney severely to lead to renal failure. Lupus involvement of the joint is called lupus arthritis, and this can be the initial symptoms that some patients develop. Brain involvement can result in seizures, psychosis, confusion, cloudiness of thought with forgetfulness –what we call lupus fog. But note that lupus can affect other parts of the body as well.

Is lupus gender and age-sensitive? How can lupus be differentiated from arthritis since both can affect the joints?

Lupus can affect any age group, but is more common in females of childbearing age. Arthritis is not just one disease. Arthritis is a term used to describe a group of joint diseases and we have over a 100 types and causes of arthritis. The symptoms of arthritis include joint pain with or without joint swelling, and prolonged early morning joint stiffness. Lupus is a cause of arthritis. If any of these joint symptoms occur especially in a young person, it is worrisome and should be referred to a rheumatologist for full evaluation for the cause.

How common is lupus in Nigeria?

We do not have that data on its incidence in Nigeria at the moment. We are currently running a lupus registry to collate the number of lupus patients in Nigeria. But I can tell you confidently that we have over a thousand patients with lupus in the country that are being managed by different rheumatologists across the country. And we are seeing new cases every month.

Why is the condition not curable, like malaria?

In medicine, how we treat a condition depends on the type of condition itself and its severity. What we know about a condition at each point in time sets the limit to what type of medications are available to treat it. For lupus, the drugs we have now control the disease so that it will not cause damage to the body. So, just like you have in the treatment of hypertension or diabetes where the medications control the condition; so it is with lupus medications. So, treatment of lupus is lifelong.

Do patients have specific number of years to live after diagnosis?

A lupus diagnosis does not mean the individual has four or five more years to live. When a case of lupus is diagnosed, we also assess the severity of the disease. In its severe form, lupus tends to have higher morbidity and mortality, especially with the involvement of organs in the body like the kidney and the central nervous system.

But we don’t categorically say an individual with lupus have this length of time more before they die. No, lupus has different forms. In a part of the world, they give it the name ‘the disease with a thousand faces’ because it can manifest in so many ways. Each patient is managed based on how the disease is affecting their body system.

Patients who present early and that commence treatment early have better outcomes. There are immune modulatory medications that control the disease. Current treatment has improved survival. However, late presentation in the hospital with severe irreversible complications in the body is a strong limiting factor to treatment outcomes.

Also of importance to patients’ well being is adherence to follow-up clinic attendance to assess how they are responding to treatment and to monitor possible complications, including any organ damage. They should never assume they’re fine and so skip clinic.

Individuals with lupus have a higher risk of developing cancers and cardiovascular diseases, including stroke, heart attack and kidney failure because of the effect of the disease. They also are predisposed to infections. All these complications increase mortality in lupus patients.

Are there lifestyle modifications you recommend for individuals with lupus?

The human body is dynamic and it responds to what you give it either positively or negatively. Oftentimes, individuals with lupus also need to have a lifestyle change. We always recommend a balanced healthy diet, including enough fruits and vegetables, exercise, adequate rest, avoidance of stress, avoidance of smoking and no intake of alcohol. Moderate and regular exercise can help with fatigue, a common symptom of lupus, as well as improvement in their fitness level.

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A common practice is rubbing hot balms on the painful and swollen joints. How helpful is this with lupus?

How to treat painful and or swollen joints depends on their cause and severity. For mild and moderate painful joints, topical non-steroidal anti-inflammatory medication creams or gels can be rubbed in it. Many people think that if a balm is not hot, it doesn’t work. That’s not true. Newer balms now come as gels and the chemicals in them allow for their fast absorption into the skin, unlike these hot balms. So the gel does not typically require massaging. We do not encourage massaging the joint because it can worsen the condition. It ends up doing more harm than good.

Will rubbing shea butter and then wrapping the painful knee or arm help?

Some patients with arthritis say that during the cold weather, their joints stiffen so when they warm it up, it actually helps to relieve their pain. But all they need to keep it warm is to cover it, but not to wrap it up tightly and then constrict blood flow. This can cause more swelling. In some climes, some wear flexible braces. But generally, with severe lupus arthritis, non-steroidal anti-inflammatory creams could be applied as well as painkillers. But I will advise that if wrapping your joint makes you feel better, it means that the joint would be better kept warm.

Ifedayo Ogunyemi

Ifedayo O. Ogunyemi‎ Senior Reporter, Nigerian Tribune ogunyemiifedayo@gmail.com