Lupus disease - what is it, what treatments exist and what are the impacts?
Lupus, an autoimmune disease that affects more than 1 per 1,000 Canadians, has and will continue to profoundly impact the world of healthcare. It is most common in young adult females, with implications on fertility and reproductive health. In the western world, lupus is not considered rare, with increasing amounts of advocacy, education and research helping to raise awareness and draw attention to this disease.
Systemic lupus erythematosus can affect many tissues and organs in the body, and is also the most common form of lupus. Other forms of lupus involve those that mainly affect the skin or are brought on by taking certain drugs. This makes the diagnosis, treatment and long-term maintenance for lupus difficult as many different symptoms and manifestations arise as part of flare-ups, on top of an already variable disease course. However, many people with lupus live healthy, happy lives with proper lifestyle changes and therapeutic management. One well-known example is when Selena Gomez, a famous popstar and actress, received a kidney transplant due to lupus nephritis (kidney inflammation) and documented her experience on social media.
Although lupus has no cure, the aim is to treat symptoms associated with lupus and maintain low amounts of disease activity so that long-term survival and quality of life are improved. This can be done in two major ways:
1. Lifestyle management
- Sun Protection - this includes wearing sunscreen (minimum SPF of 30) and physical garments such as hats and clothing that cover exposed skin. This is important as sun exposure can potentially trigger flareups and skin rashes.
- Cardioprotective diet - this includes eating foods high in fibre, such as fruits and vegetables, and oily fish while reducing intake of processed foods and salt. Heart protection is necessary as the risk of heart disease and stroke is increased with lupus.
- Exercise - this includes aerobics, elliptical exercise, walking, swimming, cycling and many more. The impacts of exercise are multifold and help with heart, mental and physical health
- Topical corticosteroids - these therapies help treat skin rashes, which are a common part of lupus. If rashes are severe, other therapies need to be considered.
- Pain management - non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil and Aspirin help relieve pain and inflammation associated with the joints and the heart. These therapies are cautioned against in the presence of heart or kidney disease, however.
- Antimalarials - hydroxychloroquine is used to treat many patients with lupus, as it helps with both arthritis and fatigue, two of the most common symptoms of lupus. If hydroxychloroquine is started early, it reduces the accumulation of damage caused by lupus. In addition, hydroxychloroquine is usually continued to prevent flareups. The main downside to hydroxychloroquine is that it has a long list of side effects ranging from eye to heart toxicity.
- Corticosteroids and immunosuppressants - the two are usually used together in more severe disease to reduce side effects from corticosteroids. They are used to reduce inflammation in different areas of the body.
Although lupus is relatively common, it is considered an invisible disease. Without visible symptoms, it may be challenging to recognize the struggle of those who have lupus. It is so important that we acknowledge the impact of lupus on individuals and communities, and do our part in being mindful about this disease.
- Systemic Lupus Erythematosus [Internet]. 2021 [cited 2021 Oct 24]. Available from: RxTx Canada.
- Cardioprotective diet – East Sussex Healthcare NHS Trust [Internet]. [cited 2021 Oct 24]. Available from: https://www.esht.nhs.uk/leaflet/cardioprotective-diet/.
- Lupus CanadaHome [Internet]. 2016 [cited 2021 Oct 24]. Available from: https://lupuscanada.org/