The life with Lupus: timely diagnosis is crucial


In my practice, I come across many patients with osteoarthritis, a painful disease which affects 22 to 39 per cent of the population in India. Osteoarthritis is a condition of the bones, where the cartilage connecting the bones begins to break down and the bones start to grind against each other. Osteoarthritis is often confused with a condition called lupus, because of similar symptoms. More than that, the conditions are related. Many people with lupus also develop osteoarthritis, and some people with osteoarthritis may develop lupus. Lupus, however, though a common disease, is relatively unknown. It is often misdiagnosed or diagnosed with great delay, which is worrying, because the disease can be life-threatening.

Systemic Lupus Erythematosus

Lupus, or Systemic Lupus Erythematosus (SLE), is an auto-immune disease. It can damage several parts of the body, including the joints, heart, lungs, kidneys, skin, blood and brain. Auto-immune disease means that the immune system in the body, which is geared towards fighting off viruses, bacteria and germs, cannot differentiate between foreign invaders and the body’s own healthy tissue anymore. As a result, the immune system also attacks healthy tissue. This causes inflammation, swollen joints, rashes, pain, and tissue damage.

The cause of lupus is still unknown, though scientific research has shown a genetic disposition to develop the disease from viruses, infections, chemicals, ultra-violet and sunlight, or medications. These factors can trigger an overactive auto-immune response. Lupus may run in families, though changes are low that a patient’s children or siblings also have lupus. Unfortunately, there is no known cure for lupus. Moreover, the disease does not qualify as a one-cause one-cure illness. The symptoms of lupus, as well as the severity of the symptoms, vary from patient to patient and the onset of the disease in a patient is often hard to determine. Its actual clinical manifestations depend on the organs chosen by the immune system for attack. Although it’s difficult to calculate how many people currently have the disease, according to estimates based on various reports, more than 1 million cases per year are reported in India. Lupus is not contagious. It generally affects women more than men, and mostly women between the ages of 15-44. However, men, children, and teenagers can also develop the disease. Lupus is chronic and can last for years or be lifelong.

Common Lupus Symptoms

Living with lupus is not easy for patients. Symptoms come and go and manifestations of the disease are unpredictable. When symptoms develop and the disease gets worse, it’s called a flare. When patients have periods with few to no symptoms, doctors say the disease is in remission. However, symptoms rarely disappear completely. The first symptoms in most patients are fatigue and painful, stiff and swollen joints, usually in hands, wrists, and knees. People with lupus often have rashes across the face (mostly on cheeks and nose), which may increase with sun exposure. Other indicators could be mouth and skin sores, fever, weight fluctuation, hair loss, memory loss, malaise, chest pain, and depression.

Lupus symptoms often interfere with day-to-day activities. Also, the sudden showing up of symptoms can have a deep effect on the psyche of patients. Patients might choose to avoid social circles and prefer to stay inside their home. Lupus disease could also lead to frequent mood changes and negative thinking, leading to feelings of depression. This not only affects the patient but engulfs the entire family. Lupus might affect the economic front; patients who work in a highly demanding work environment might find it difficult to cope with their physical alterations. Moreover, when symptoms get more severe, they might not be able to do physical work due to the pain, or feel overwhelmed by fatigue.

Lupus, unfortunately, is difficult to diagnose and difficult to treat. Early diagnosis, however, is very important because of potential organ damage when the flares get more severe. Moreover, lupus is a disease which aggravates if left unattended. Due to its severe consequences, lupus should always be treated by a doctor. In order to diagnose the disease, your doctor will look at your medical history, do a physical examination, and perform some laboratory or x-ray tests. Treatment will focus on improving quality of life through controlling symptoms and minimizing flare-ups. The treatment plan will be geared towards the patient’s personal situation, her or his specific symptoms and the organs involved, which, as said, can differ from person to person. Prescribed medicines will mainly focus on reducing inflammation due to the auto-immune reaction. With good medical care, most people with lupus can live normal lives, though regular and proper monitoring is crucial.

The key to controlling the disease is preventing flares. Luckily, there are many things a patient can do to help moderate the effects of this unpredictable disease:

  • Stick to the prevention and treatment plan developed by your physician. Take all medications. Ask your doctor which over-the-counter or prescription drugs to avoid because they could cause a flare. Visit your physician regularly to monitor the disease.
  • Stay healthy: get plenty of rest, eat well, don’t smoke, and exercise.
  • Minimise stress. Stress is a major cause of flares. Try to relax and learn de-stressing exercises.
  • Stay active. This will help keep joints flexible, keep the body strong and better able to fight the disease. Exercise may also prevent cardiovascular complications.
  • Avoid excessive sun exposure; use sunblock, hats and sunglasses; plan outdoor activities for later in the day, if possible.
  • Maintain normal body weight and bone density. Bone loss in lupus may occur as a direct result of the disease. Moreover, pain and fatigue caused by the disease can result in inactivity, which increases osteoporosis risk.
  • Female patients with a pregnancy wish should consult their doctor as to the best timing and medication use

Above all, awareness about the disease will help patients in controlling the disease. We need to increase awareness amongst the public and the medical profession of the warning signs and symptoms of lupus, so that the disease does not go undetected. If left untreated, patients might be confronted with complications that are too aggressive for any treatment to work. This is a situation we should avoid at all times. So, let us spread that awareness and help control the impact of this debilitating disease. Let’s make sure that people with lupus can expect to live a normal lifespan.


Dr Chandan NagAbout Dr. Chandan Nag Choudhury: Dr. Chandan Nag Choudhury is an orthopaedic surgeon with Ayursundra with a special focus on Hand, Foot Reconstructive & Joint Replacement Surgery.
With an MS in Orthopaedics from Mahatma Gandhi Memorial Medical College and Maharaja Yashwant Rao Group of Hospitals, Indore, and a M.CH (Orthopaedics) from the American Academy of Continuing Medical Education, Dr. Choudhury did a Fellowship AO (Trauma) in Switzerland, and a Fellowship In Hand And Foot Reconstructive Surgery in Mumbai under the guidance of Dr. B.B. Joshi, the father of hand and foot surgery in India.

Dr. Choudhury worked at several hospitals in Assam, being actively involved in various orthopaedic procedures and joint replacement cases. It is his aspiration to add a new superspecialty Hand And Foot Solution Unit in the Northeast.

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