When my mobile rang showing an unknown number, I expected a marketing call for a new credit card or a car loan! I was pleasantly surprised when the caller started off by wishing me, “Happy World Lupus Day, Doctor!” When she introduced herself, I realised that it was a patient who had been treated by me for Systemic Lupus Erythematosus (SLE) during her pregnancy. She had delivered a baby girl last month and the family was happy that the pregnancy had been without any complications despite the SLE.
SLE is a chronic, autoimmune disease that causes inflammation in and can damage any part of the body including skin, joints, and organs like the heart, lungs, kidneys and brain. Autoimmune refers to the process of the body’s immune system turning against itself. Globally, around 5 million people suffer from SLE. It is around eight times more common in women than in men. The prevalence is lower in India, but with urbanisation and changing lifestyle, there has been an increase in the occurrence of SLE.
SLE is difficult to diagnose as it mimics many other diseases. Its primary symptoms are a non-specific fever and skin rash which are also the symptoms of many other diseases. Due to this, SLE is difficult to diagnose, and patients sometimes suffer for years without diagnosis and incorrect treatment. This delay in diagnosis can also be fatal if the inflammation involves a major organ. World Lupus Day is celebrated on May 10th each year to create greater awareness and understanding of lupus, so that diagnosis can be made early. The word ‘Lupus’ comes from the Latin word for wolf, and early diagnosis and treatment can help to ‘cage the wolf’ and prevent complications from tissue and organ damage resulting from the inflammation. As there is no ‘cure’, treatment focuses on easing the symptoms through suitable medicines such as anti-inflammatory drugs, corticosteroids, hydroxychloroquine (used to treat malaria). Immunomodulators, medicines which modify the immune systems response are also used in the management of SLE. Monoclonal antibodies offer a new line of treatment to patients who do not respond to conventional line of treatment.
The symptoms of lupus range from the mild to the life threatening and many people have long periods with few or no symptoms before experiencing a sudden flare-up, where their symptoms are particularly severe. This peculiarity plays a major role for women with SLE during pregnancy.
Many women with SLE are worried about getting pregnant because of potential problems during a pregnancy. But SLE does not reduce a woman’s chances of getting pregnant. Also, less than 50% of pregnancies in women with lupus have complications. All lupus pregnancies are considered high-risk, as complications like miscarriage, premature delivery, and preeclampsia (sudden rise in blood pressure) can occur. Proper treatment started early on in the pregnancy to counter risks of complications ensures a safe pregnancy. Regular visits to the doctor can help to monitor the baby’s growth, as well as the kidney and liver for any damage and also catch and treat any flare ups in the SLE early.
Pre conception counselling and a multi-disciplinary approach with the rheumatologist, obstetrician and paediatric cardiologist is an important factor in the successful management of pregnancy in a patient with SLE. At Aster MIMS Calicut, we have successfully caged the ‘lupus’ wolf and helped over 150 women with SLE have a safe and happy outcome to their pregnancies.
Sr. Consultant and HOD
Rheumatology
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