Lupus
Lupus is a chronic immunological disease characterised by the production of antibodies. It mainly affects women of child bearing age, evolves into flare-ups and can affect any organ.
It is characterised by the production of immune complexes found on any organ and that cause inflammation and, in some cases, even organ damage. The cause is unknown but is understood to be down to multiple factors. Genetic, environmental and hormonal factors play a role.
These cause a change to apopstosis (cell death) that means new antigens appear and the innate and the adaptive systems are activated, which are responsible for producing antibodies.
Symptoms
The most common symptoms are: joint pain or arthritis (85-90 %) and skin lesions (70 %), but it may also affect any organ.
Lupus can affect different parts of the body:
- the cardiovascular system, with pleurisy and pericarditis
- the haematological system, with leukopenia/lymphopenia and thrombocytopenia
- the kidneys in the form of glomerulonephritis, which affects 40 % of patients, and which has the worst and most serious prognosis together with neurological manifestations.
Who is affected by lupus?
Lupus mainly affects women, with a ratio of 9:1 of those affected being of childbearing age, although it may appear during childhood or later in life.
Its is prevalent in 10/10,000 people of Caucasian origin, but is more prevalent and severe among African American and Hispanic patients.
With improved treatment in developed countries, the survival rate is over 90% after 20 years, although the disease’s effects on the renal and central nervous system increase morbidity and mortality.
Diagnosis
Diagnosis is founded on clinical suspicion based on the symptoms described and laboratory data showing the presence of antinuclear antibodies and anti-dsDNA antibodies, which are specific to the disease. The criteria provided by the American College of Rheumatology is used for diagnosis. If the patient fulfils 4 of the 11 criteria, they are classified as having systemic lupus erythematosus.
Typical treatment
Treatment is specific to each case. In general, anti-inflammatories, cortisone and antimalarial drugs are used. In severe cases, immunosuppressants may be used (Imurel®, methotrexate and mycophenolate, for example), or to avoid flare ups, lasting effects and also reduce the need for corticosteroids. In the last 50 years, only belimumab, or anti-BLys, has been approved for the treatment of lupus.
Prevention
Unfortunately there is no preventative treatment for lupus. The most important factor to avoid lasting damage is early diagnosis and treatment by experts in the field.
Providing patients with the right information at the time of diagnosis is essential to prevent future complications, as is treatment monitoring.
