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‘Early detection is required to prevent and treat lupus’

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Adelowo

The President, African League of Association of Rheumatology and Consultant Rheumatologist at Lagos State University Teaching Hospital (LASUTH) Ikeja, Prof. Femi Adelowo has said that early detection is required on treatment, management and preventions of lupus diseases.

Adelowo noted this at the association’s enlightenment programme organised for lupus patients to mark 2021 World Lupus Day, with the theme ‘Making Lupus visible’ held at LASUTH.

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He stated that systemic lupus erythematosus (SLE), often shortened and called lupus, is a condition belonging to the group of diseases called auto-immune diseases. There are many other conditions classified under this particular group, such as scleroderma, polymyositis, dermatomyositis and antiphospholipid syndrome. Lupus is a rheumatological condition characterised by episodes of acute and chronic inflammation in the body.

Adelowo disclosed that there is no known identifiable cause of lupus. “But we know it is due to interplay between some environmental factors, possibly an infection with certain viruses plus a genetic predisposition in the background of a hormonal factor. It is a typical case of auto-immune disease, which basically means ‘body at war with itself’. Various other factors have been suggested, such as the effect of ultra-violet ray of the sun, use of certain cosmetics, drugs such as methlydopa, procainamide and hydralazine, among others”, Adelowo said.

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He, however, stated that Lupus has protean manifestations and can present in a variety of ways. In Nigeria, however, the commonest symptoms are recurrent fever, joint pains, skin rashes, fatigue, mouth sores, loss of hair, anaemia and epileptic seizures.

Adelowo explained that the blood is mainly fluid, but embedded in it are distinct cells. And though not obvious to the human eyes, they can be seen through the microscope. There are three basic types of cells. These include red blood cell, which transports oxygen hormones and nutrients from one part of the body to another. The haemoglobin in them is what ‘gives life.’ There are also platelets. These are cells that plug our skin and any damaged organ, when there is injury and thus prevent us from bleeding to death. The third are white blood cells, which are the ‘soldiers’ of the body. And like all soldiers, they are arranged into various ‘divisions’; ‘company’, ‘battalion”, he said.

Addelowo further explained: “Each grouping has specific ammunition to fight enemy germs, which abound in the food we eat, the water we drink and the air we breathe. These white cells ‘soldiers’ are forever patrolling in our blood vessels, rounding up germs and killing them. Our body does not normally fight itself because our ‘soldiers,’ the white blood cells recognise what is self because of the ‘uniform’ protein that the cells have”.

“For many reasons, Medical Science does not quite understand why some of these ‘soldiers’ gang up together and become ‘rogue cells ‘ or ‘area boys’ and start attacking the body and not the germs. It is these rouge cells that cause inflammation and damage.

Auto-immune disease can occur in any structure, including the eyes, mouth, brain, kidneys, lungs, liver and even the womb. The net effect is inflammation in any of these organs and damage”.

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He said: “SLE does not usually impair ability to get pregnant. Lupus patients are as fertile as non-lupus patients. However, a small number may have difficulties with sexual intercourse. In such a case, the patient will be having pains, and stiffness in joints, especially the pelvis, and associated with mechanical difficulties”.

“The symptoms during pregnancy include fatigue and dryness in vagina, making sexual intercourse painful. Long standing (chronic) diseases may disturb egg release (hypogonadism). Some women will be having fear of getting pregnant because of possible “transmission” of lupus from mother to baby. Some drugs such as methotrexate may decrease libido”.

“Certain syndromes associated with lupus, such as antiphospholipid syndrome may prevent implantation or foetal death. This syndrome may also cause thrombosis clotting in blood vessels of many organs”.

“The disease is uncommon in urban Nigeria. It constitutes about five to eight per cent of all cases seen in a Rheumatology clinic. It is rarely seen however in rural Nigeria suggesting some environmental factors as industrial pollution and motor vehicle pollution in urban areas”.

Asked, what is the treatment for the disease. He said, “Quite a lot of medications are available. Since lupus potentially affects every organ and all organs of the body, including the skin, joints, lungs, heart, kidneys, liver, brain, womb and eyes, there are specific medications for specific organs. However, the objective of the treatment is to suppress those ‘rebellious white blood cells’ waging war on the body.

“Thus, the group of drugs called immune suppresants are deployed in different combinations. They include steroids, hydroxychloroquine, azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine, tacrolimus, dapsone and thalidomide”.

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Adelowo disclosed that there are still some unmet needs in terms of treatment. “We have two new effective agents produced by biotechnology and directed at a particular form of white cells called B lymphocytes. These cells appear to be a major culprit in setting up the inflammation causing the damage to tissues. The two available drugs are rituximab and belimumab. However, any of the drugs mentioned are not to be self-administered. The Rheumatologist is trained to handle the administration and adverse effects.

On how lupus can be prevented, he said. “Unfortunately, there are no particular measures to prevent it, since those who are predisposed to develop it will still have it. However, in families of those who have it, regular check of the tests called anti-nuclear antibody, if positive, will indicate that such persons may develop lupus at some time, or have manifestations of lupus. Early detection will result in early treatment and prevention of internal organ affectation. Otherwise, there are no known medications that will prevent it”.

He said there has been an increase in the number of SLE patients seen in Nigeria. This is due to such factors as an increasing awareness of lupus by doctors generally, increased awareness in the community, a significant rise in the number of rheumatologists from just one in early 2000s to more than 50. This number is distributed in all the six zones of Nigeria, such that a rheumatologist is just about 100 to150 kilometres away. There is also increasing teaching of this condition to medical students, who will end up practising in hospitals as doctors”, Adelowo said.

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