System lupus erythematosus (SLE) symptoms, diagnose and treatment (Part 2)

Hi friends my name is Hadi Rana welcome to part 2 of systemic lupus erythematosus (SLE) symptoms, diagnose and treatment.

lupus erythematosus

             In lupus we will have to give steroids in the initial phases at higher doses. Normally, for a common man, steroids are not good for their health because they actually decrease their immunity, but in lupus immunity is affecting their own body, it is immunity which is at fault so we have to control this immunity and that is why steroid become very important in the initial phases of lupus.

     In the long term, we do not want to continue very high doses of steroid . We should have put steroids at very low doses which do not cause any harm to you. Basically we will be maintaining a very low dose of steroid, but since we do not want the disease to increase as we decrease the steroid, we add on something called steroid sparing agent, which have the same effect as that of steroids usually have. These steroid sparing agents are very helpful in lupus in controlling the disease for long term and also in improving the survival of the patient.

     Usually people who have lupus can have a  mild disease where they may have a mild disease where they may have only skin or joint involvement or a minimal decrease in their blood count or they may even have a severe disease where their kidney and nerves are getting affected depending on the severity of the disease the treatment for the individual person can change. There could be people who are only given low doses of steroids. people who are given very high doses of steroids, people who are given steroid sparing agents immunodepressants which are mild  or immunosuppressants which are severe. This depends on the stage of the disease and treatment can vary.

     For people who  do not take treatment, what would happen is initially the disease is in a treatable phase. If we start off in the early stage of any kidney disease, the kidney can come back to completely normal. If we do not do that in the long term the kidney could be damaged. There could be an increase in creatinine. You may have to be put on dialysis or you may have to go for a renal transplant also.

     Lupus is not a small disease to have, there could be a lot of complications even in people who are regular with treatment. There could be flares in particular situations like whenever your doses are suddenly decreased or you stop medications for a few days or you are going through a stressful situation where in the decrease  may suddenly increase and  it may become very difficult at times to control the disease and make it completely normal. It has been known that who have lupus at the end of five years out of every 100 patients, only 90 of them would survive. A lot of research is happening on the subjects to see that even these 10 people lead a normal life but that's how the disease is at this stage at present.

     Basically what doctors expect from the patients end is a regular follow up with regular monitoring and treatment as advised and keep doctors regularly informed about any new symptoms that they develop. So in the initial few years doctors may ask you to come for monthly or bimonthly checkup. Once doctors finds that the disease is completely under control and doctors have complete control on the situation, then doctors would ask you ever 3-6 months and accordingly modify the medications.

     Certain patients with lupus who are well under control can be completely off most of the medications or may have to continue with just 1-2 medications. The precautions that doctors expect from the patients end; first thing is that UV rays have been found to increase lupus. They increase the production of ANA within the body and can worsen the disease. So what doctors usually expect from the patients who have lupus is that they do not get exposed to sunlight between 10am-4pm and even if they have to get exposed due to some reasons, it is better that they use sunscreens like hats or umbrella to avoid direct exposure to the sun.

     Second thing is practicing a very healthy life style i.e. 40 to 50 minutes exercise per day along with a good balanced diet i.e. eating a lot of green leafy vegetables, fruits, taking a lot of milk and milk products and avoiding a lot of oily and junk food. These are the  things that doctors expects from the patients with lupus. another thing is that they have to protect themselves from infection as much as possible. So personal hygiene and hygiene at home is something that is very important and avoiding overcrowded places where you can easily catch an infection, this is the one more thing that you need to understand because as such your immunity is not working very well and on top of that doctors gave is immunosuppressants which can further decrease your immunity. So developing infection is something that is very commonly seen in patients with lupus. Another thing that a lot of people have a doubt about is that usually most of the patients are very young, they are very young, they are between 15 to 30 years of age the age where they get married, they may have to plan a family and they will have to handle their kids after that.

     Mostly parents and patients with lupus or their husbands keep asking whether they can actually lead a normal life, whether they can plan a pregnancy in the future, will their child have any problems? first thing is that if a patient have lupus and it is completely under control and a pregnancy is planned then don't worry you can have a complete normal baby with absolutely no problems. The outcomes of pregnancy in lupus are such as much as that of a normal pregnancy only, lupus should be completely under control, which is the most important thing.

     Lupus is not a disease that will spread to your baby post-delivery, so that is one thing that you really need not to be worried about. Definitely a patient with lupus have to plan pregnancy whenever your rheumatologist says that your disease is completely under control. During pregnancy you may require more check-ups, more regular monitoring compared to any other person. So considering that lupus is such a vast disease with so many manifestations, if you have lupus then you should meet a rheumatologist to find out which organ is affected and how severe is your lupus and the treatment needs to be adjusted by them accordingly.