Dr. House's favorite diagnosis: What is lupus?

In September 2017, Selena Gomez told the world, that she had a kidney transplant, the singer's best friend became a donor. The cause of the operation was an autoimmune disease - systemic lupus erythematosus. This house was made famous by Dr. House from the show of the same name: the diagnosis of lupus due to its numerous and diverse symptoms became the real meme of the series. We decided to find out what the disease is and who might face it.

What is the "lupus"

Most often, this term refers to systemic lupus erythematosus, but in fact there are several lupus erythematosus. Systemic lupus erythematosus is the most common type, it can be of varying degrees of severity and can affect many parts of the body. With discoid lupus, a red rash appears that does not disappear, and with subacute dermatitis after an exit to the sun ulcers appear on the skin. There is also drug lupus caused by some drugs and disappearing after their cancellation, and neonatal, occurring in newborns. The latter is probably associated with some antibodies that the child receives from the mother.

Systemic lupus erythematosus is an autoimmune disease; it occurs when the human immune system mistakenly starts attacking its own cells and tissues. Inflammatory processes caused by lupus, can cover almost all organs and systems of the body: joints, skin, kidneys, blood cells, brain, heart, lungs. The disease develops ten times more often in women than in men, it usually appears at a young age (15-45 years) and is more characteristic for people of African, Latin American, Asian origin than for Caucasians. The science does not know the exact cause of lupus; probably, a combination of factors leads to its development. The role of genetics has been proven, but the environment also affects: lupus occurs more frequently in developed countries.

How is she diagnosed

To the delight of the writers of "Doctor House", lupus is difficult to diagnose: it can be disguised as other diseases. One of the characteristic signs of lupus is a rash on the face, similar in shape to the wings of a butterfly. True, it does not appear in all - and indeed there are no two patients in whom the manifestations of this disease would be the same. Other symptoms of systemic lupus erythematosus may include pain or swelling in the joints, unexplained fever, pain in the muscles or chest during a deep breath, pallor and blueness of the skin, especially on the hands and feet, increased sensitivity to sunlight, swelling of the legs and face, chronic fatigue . Symptoms may appear and disappear, there may be more or less.

Finding a diagnosis can take months, and sometimes years. A good role is played by a good connection between the doctor and the patient and attentiveness to one's health: it is very important to tell the doctor about all the symptoms and how they appear, how long they last and when they pass. The American College of Rheumatology has developed a checklist of 11 signs, and for making a diagnosis of systemic lupus erythematosus it is enough to have four of them. Unfortunately, there is no laboratory parameter that allows you to confirm or deny lupus with certainty. Nevertheless, blood and urine tests help the doctor orient. You may also need a chest x-ray and an echocardiogram (ultrasound of the heart). Since lupus affects the condition of the kidneys, a biopsy of the kidney is often performed to clarify the diagnosis - a small piece of tissue is taken for examination under a microscope.

Why is she dangerous

The danger of systemic lupus erythematosus is that the inflammatory process spreads to many tissues and organs, disrupting their work. One of the main causes of death for this disease is renal failure, because lupus seriously damages the kidneys. If the brain and the nervous system are affected, there may be headache, dizziness, changes in behavior and mood, visual disturbances, and sometimes the situation is complicated by cramps or stroke. Many lupus patients complain of loss of memory and difficulty in articulating thoughts. The disease can affect blood cells, and then anemia appears and the risk of bleeding or, conversely, thrombosis increases. Also, lupus does not leave vessels aside and causes vasculitis, an inflammation of the vascular wall. With lupus, both the lungs and the heart may suffer. Mortality among people with lupus is higher than in the general population.

Another problem is that women with lupus have an increased risk of miscarriage and such complications as preterm birth. To try to reduce the risk, doctors recommend planning a pregnancy for a period when the disease has not worsened for at least six months in a row. With systemic lupus erythematosus, depression often occurs, and it can be based on different mechanisms. It can be a manifestation of autoimmune inflammation of the central nervous system or the patient’s response to one’s well-being and social aspects of the disease, as well as a side effect of medications. Therefore, besides a rheumatologist, a neurologist and a psychiatrist should be involved in the observation.

How is it treated

Treatment of systemic lupus erythematosus is selected individually, because it depends on those disorders that have already occurred in the body. Therapy can be very different in periods of exacerbations and remissions. The main tasks are to prevent aggravation and remove it if it has already developed, and also reduce damage to organs. Therapy usually includes anti-inflammatory drugs, drugs for the treatment of malaria (they affect the immune system and can reduce the frequency of exacerbations), corticosteroids, immunosuppressants, biologic drugs, monoclonal antibodies, opioids and other drugs.

How to help yourself or loved ones

If you know someone who has lupus, or encountered it yourself, remember that many patients with this disease live a normal, full life. It is very important to build a support system around you that will include a doctor, family and other close people. The doctor-patient relationship plays a very important role in controlling the disease, and family and friends can be a reliable support during periods of exacerbation. It is important to participate in taking care of yourself, to study and know your illness - this will allow you to be ready for its sudden turns and understand what to expect from the treatment. On the Web, you can find resources to support patients, where people with systemic lupus erythematosus share their stories.

You need to stay active, because exercise helps to keep joints and muscles in good shape and prevents disorders of the blood vessels and the heart. It is important to remember that exposure to the sun can cause lupus eruptions or even provoke an exacerbation. T-shirts with long sleeves, sanskrins and wide-brimmed hats are the best helpers on sunny days (however, this also applies to all other people).

Photo: Alexander Potapov - stock.adobe.com, thawats - stock.adobe.com