Rheumatology Fast Fact: LUPUS

By Dr Roberto Russo, Rheumatologist

The mention of the term Lupus often incites fear in those suspected of having the disease, as classically demonstrated by the character George Costanza in the television series Seinfeld.

This concern is justifiably founded in the fact that Systemic Lupus Erythematosus (SLE; as it is frequently referred to) can have devastating effects, which in some may result in a premature death. However the extent of the hysteria is generally exaggerated, as in most the disease has mild manifestations that are usually responsive to simple therapeutic interventions.

SLE is an autoimmune disease that can affect almost any organ of the body.

In other words, the immune system has been stimulated to inappropriately attack itself/host tissues. The trigger for this aberrant function is thought to be an environmental agent (such as infection) in a genetically predisposed host. The incidence is relatively low, estimated at about 40-50/100000 people and for various reasons females are much more often affected.

The diagnosis of the disease involves a combination of both clinical manifestations and serological investigations.

The clinical manifestations are quite broad and include various forms of skin rash, of which some are triggered by UV light, as well as, joint symptoms, oral ulcers, hair loss, serositis, and symptoms suggesting renal, neurological, and haematological dysfunction. The photosensitive skin rash often affects the cheeks and bridge of the nose, from which the latin term Lupus derives given its resemblance to the appearance of a wolf. The most useful immunological test assesses for the presence of anti-nuclear antibodies (ANA). If these are absent then the disease is very unlikely.

On occasion, patients may present initially on the basis of their joint symptoms.

1. the arthralgia, or joint pain, is often non-specific;
2. The most common joints involved are distal, usually in the hands;
3. There may not be any clinical evidence of inflammation, with no joint effusion obvious on examination;
4. Patients generally describe typical inflammatory features with stiffness being a prominent;
5. When arthritis occurs it does not classically lead to erosive destructive change. However, joint deformity can occur due to lax ligaments;
6. The symptoms are generally responsive to anti-inflammatory medication, such as NSAIDs. For more severe and persistent disease, low dose corticosteroids can be effective and the immunomodulating drug, Plaquenil (Hydroxychloroquine) is quite effective.

Although this snapshot of SLE is far from exhaustive, the intention is to increase your understanding and awareness of this disease and to give you some insight into the musculoskeletal manifestation.

Non-specific joint symptoms can sometimes be part of some sort of systemic disorder.

If you or someone you know suffers from the symptoms described above, a full assessment by a rheumatologist may be required.

Dr Roberto Russo is both a rheumatologist and a nuclear medicine physician, as well as a director of BJC Health.

Arthritis requires an integrated approach. We call this, Connected Care. Contact us.