As World Lupus Day is marked on Thursday, May 10, patients have been advised to visit Rheumatologists for treatment, rather than think the sickness is spiritual attack. Due to confounding presentations, baffled patients are often told that the disease is due to spiritual attack. As a result, valuable time is lost, which delays proper management.
The disease is said to belong in a group of diseases called connective tissue disease or autoimmune disease. In this condition, the “body is at war with itself,” as the protective white blood cells (soldiers) in the blood, which normally defend the body from germs, mistakenly and crazily turn their weapons on the body rather than germs.
It is akin to what happens, when some soldiers, rather than defending their country, turn their ammunition on the country in form of a coup. Of course there would be resistance from loyal soldiers and the resultant ‘rofo rofo” fight causes a lot of destruction and damages. It is the debris of this fight in the human body causes inflammation and damage in the body.
Rheumatologists have explained that lupus affects mainly girls and women of childbearing age in the age bracket of 20 to 40 years, mostly in their 30s. Previously, it was believed that the disease was rarely seen among black Africans, but this has now been discovered to be untrue, due to major research conducted in Nigeria. It uncommonly affects older women and rarely affects men and children.
Femi Adelowo, a Professor of medicine and Consultant Rheumatologist at Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, said causes of lupus is unknown for now, though there are many hypotheses for it and other autoimmune disease.
He said: “One thing certain is that the disease results from a malfunction of the protective system immune system, in which it fails to recognise what is ‘self’ and mistakes part of the body as alien to it. Some persons and family also appear prone to these conditions. “It is all in their star” that is genetic predisposition.”
He explained that the commonest presentations among Nigerians include, persistent fever, which is often erroneously treated over and over as malaria, typhoid, tuberculosis, joint pains, extreme fatigue, skin rashes- usually exacerbated by exposure to sunlight, mouth or throat sores, marked loss of weight, anaemia often resulting in repeated blood transfusions and chest pain. Others are seizures, loss of memory and unexplained hair loss.
Adelowo said: “A specialist trained in the management of Lupus is called a rheumatologist. Over the past eight years, there has been an increased number of Nigerian rheumatologists practising at centres in Maiduguri, Jos, Zaria, Kano, Abuja, Ilorin, Enugu, Owerri, Nnewi, Abakaliki, Uyo, Calabar, Benin, Asaba, Ibadan, Ile Ife, Sagamu and Lagos.
“Probably the most troublesome complication is kidney disease. More than one third of our patients present to us with some evidence or kidney disease. This arises mostly due to delay in presentation. A few of our patients actually have kidney disease and it is only in the process of investigations they are discovered to have lupus.
“Other complications are stroke, paralysis of both legs, such psychiatric presentation as depression and in extreme cases, psychosis. There are also recurrent pregnancy loss, chest infections and scarring of the lungs in more severe cases.
“For treatment, the rheumatologist will order a few blood tests to see if there is anaemia or infection, as well as to assess kidney functions. Such tests will include blood and urine tests. For a definite diagnosis of lupus, he will order serology tests that demonstrate various of these autoantibodies ‘self directed ammunition.’ Other tests may assess the lungs, heart and brain as needed”.
Adelowo said a lot of medications are available for treatment of lupus. Since the condition 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,” he explained. “Thus the group of drugs called immunosuppressive is deployed in different combinations. They include steroids, hydroxychloroquine, azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine, tacrolimus, dapsone and thalidomide. There are still some unmet needs in terms of treatment.
“As such, over the past 10 years or so, we have two new effective agents produced by biotechnology and directed at a particular form of white cell called B lymphocytes. These cells appear to be major culprits in setting up inflammation causing damage to tissues. The two available are Rituximab and Belimumab.”
Dr. Olaosebikan Hakeem, a Consultant Rheumatologist at Lagos State University Teaching Hospital (LASUTH), said: “So many lives have been lost because of erroneous beliefs that the disease is a result of spiritual attack. But it is due to the delay before medical treatment is sought. So much herbal medicines would have been given to patients. So many families have been destabilized because of these false beliefs. This condition also occurs in the Western world and they do not spiritualise illness the way we do; and they get better!”
“Early referral to a rheumatologist makes a lot of difference. If the general practitioner sees a patient with lupus symptoms, an early ESR will point towards the diagnosis, which will be very high in the neighbourhood of 80 percent and above.
“Many of the drugs used to treat lupus are also used in the management of cancer. But then, drugs can have multiple functions, for instance, aspirin. Of recent, a new group of drugs called biologics have been developed. These are rituximab, belimumab, and abatacept. Other modalities of treatment are intravenous immunoglobulin and plasma phareses.
“Lupus patients must also use sunscreen, as excessive sunlight predisposes to attacks. They should avoid physical and emotional stress. They should eat well and rest. Overall, we have in our custody very effective medications and we can switch from one to another as the case may be.
“There is hope for patients, because a lot of specialists have been trained. Life expectancy is as in normal persons, if the patient takes his/her drugs and goes for follow up. The chances of survival are high.”
Hakeem explained that blood is mainly fluid, but embedded in it are distinct cells, not obvious to the human eyes but which can be seen when looked at with microscope.
He said: “There are three basic types of cells. Firstly, red blood cells, which transport oxygen hormones and nutrients from one part of the body to another. The haemoglobin in them is what gives life. Secondly, there are platelets. These are cells that plug the skin and any damaged organ, whenever there is injury and thus prevent us from bleeding to death. Thirdly, you have white blood cells, which are the ‘soldiers’.
And like all soldiers, they are arranged into various divisions, company and battalion.
“Each grouping has specific ammunition to fight enemies germs, which abound in the food we eat, the water we drink and the air we breathe. The white cell soldiers are forever patrolling in our blood vessels, rounding up germs and killing them. Our body does not normally fight itself because the white blood cells soldiers recognise what is self because of the uniform protein they have.”
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