Light with Dr Rukarwa (Part 1)
some of these conditions due to its effect on the body. Environmental transformations have been ongoing worldwide and with increase in pollution levels, as well as toxic chemical and solvent exposure these have been implicated as well. Silica dust exposure is also a common environmental trigger for these diseases. Lastly certain drugs and infections, most commonly viral infections as well as some bacterial infections have been identified as triggers of immune dysregulation resulting in the development of many autoimmune diseases. More recently with the advent of the COVID-19 pandemic, there was a spike in autoimmune diseases in patients after having suffered from the disease, highlighting the role of infections. Another reason for the increased prevalence is better recognition and diagnosis of these conditions by doctors as well as better recording of statistics.
How frequently do you encounter patients with autoimmune diseases in your practice?
So as Rheumatologists we deal with only some of the autoimmune conditions and you find that some of them may present to other specialties such as Endocrinologists, Gastroenterologists and Neurologists. So for us the commonest autoimmune disease include Rheumatoid Arthritis and Systemic Lupus Erythematosus (Lupus), and I would say I get to see and diagnose a patient with such conditions on a daily basis. So these diseases are more common than people realize.
Which one(s) would you say are more prevalent in Botswana?
When it comes to autoimmune conditions, in rheumatology the most common ones include, Rheumatoid Arthritis, Lupus, and rarer ones such as Systemic Sclerosis and Inflammatory myopathies. Other common autoimmune disease managed by other sub- specialties include thyroid diseases such as Grave’s Disease and Hashimoto’s thyroiditis and Type 1 Diabetes Mellitus. Others include liver conditions as Autoimmune Hepatitis, Inflammatory Bowel Diseases and neurological ones like Multiple Sclerosis and Myasthenia Gravis just to name a few. So these are some of commonest conditions just to name a few. And due to the common genetics as well as triggers, an individual can at times present with a combination of autoimmune disease, though rare.
What I usually hear from patients is that they become ill, seemingly out of the blue. They would have had the typical cold or other commonly acquired illnesses of otherwise healthy individuals. And then it escalates. Are there usually symptoms one can specifically look out for and come to you with?
With most autoimmune diseases, their onset can be quite insidious, meaning they proceed gradually in a subtle way, but at times they can have a rapid onset of severe symptoms. In terms of the type of symptoms, they vary and depend on the specific disease a patient has, and usually these patients would have sort medical care at one point or another before a definitive diagnosis is made. Common non-specific symptoms in rheumatology include what are called constitutional symptoms such as
fatigue, loss of weight and at times fevers. Other common things include rashes, muscle weakness and joint pains with or without swelling and also those symptoms where a patient has been unwell for some time and there is trouble really knowing what the cause is.