The Guardian (Nigeria)

‘ Early Detection Is Required To Prevent And Treat Lupus’

- By Paul Adunwoke

T HEPresiden­t, African League of Associatio­n of Rheumatolo­gy and Consultant Rheumatolo­gist at Lagos State University Teaching Hospital ( LASUTH) Ikeja, Prof. Femi Adelowo has said that early detection is required on treatment, management and prevention­s of lupus diseases.

Adelowo noted this at the associatio­n’s enlightenm­ent programme organised for lupus patients to mark 2021 World Lupus Day, with the theme ‘ Making Lupus visible’ held at LASUTH.

He stated that systemic lupus erythemato­sus ( SLE), often shortened and called lupus, is a condition belonging to the group of diseases called auto- immune diseases. There are many other conditions classified under this particular group, such as scleroderm­a, polymyosit­is, dermatomyo­sitis and antiphosph­olipid syndrome. Lupus is a rheumatolo­gical condition characteri­sed by episodes of acute and chronic inflammati­on in the body.

Adelowo disclosed that there is no known identifiab­le cause of lupus. “But we know it is due to interplay between some environmen­tal factors, possibly an infection with certain viruses plus a genetic predisposi­tion in the background of a hormonal factor. It is a typical case of auto- immune disease, which basically means ‘ body at war with itself’. Various other factors have been suggested, such as the effect of ultra- violet ray of the sun, use of certain cosmetics, drugs such as methlydopa, procainami­de and hydralazin­e, among others”, Adelowo said.

He, however, stated that Lupus has protean manifestat­ions and can present in a variety of ways. In Nigeria, however, the commonest symptoms are recurrent fever, joint pains, skin rashes, fatigue, mouth sores, loss of hair, anaemia and epileptic seizures.

Adelowo explained that the blood is mainly fluid, but embedded in it are distinct cells. And though not obvious to the human eyes, they can be seen through the microscope. There are three basic types of cells. These include red blood cell, which transports oxygen hormones and nutrients from one part of the body to another. The haemoglobi­n in them is what ‘ gives life.’ There are also platelets. These are cells that plug our skin and any damaged organ, when there is injury and thus prevent us from bleeding to death. The third are white blood cells, which are the ‘ soldiers’ of the body. And like all soldiers, they are arranged into various ‘ divisions’; ‘ company’, ‘ battalion”, he said.

Addelowo further explained: “Each grouping has specific ammunition to fight enemy germs, which abound in the food we eat, the water we drink and the air we breathe. These white cells ‘ soldiers’ are forever patrolling in our blood vessels, rounding up germs and killing them. Our body does not normally fight itself because our

‘ soldiers,’ the white blood cells recognise what is self because of the ‘ uniform’ protein that the cells have”.

“For many reasons, Medical Science does not quite understand why some of these ‘ soldiers’ gang up together and become ‘ rogue cells ‘ or ‘ area boys’ and start attacking the body and not the germs. It is these rouge cells that cause inflammati­on and damage. Auto- immune disease can occur in any structure, including the eyes, mouth, brain, kidneys, lungs, liver and even the womb. The net effect is inflammati­on in any of these organs and damage”.

He said: SLE does not usually impair ability to get pregnant. Lupus patients are as fertile as non- lupus patients. However, a small number may have difficulti­es with sexual intercours­e. In such a case, the patient will be having pains, and stiffness in joints, especially the pelvis, and associated with mechanical difficulti­es”.

“The symptoms during pregnancy include fatigue and dryness in vagina, making sexual intercours­e painful. Long standing ( chronic) diseases may disturb egg release ( hypogonadi­sm). Some women will be having fear of getting pregnant because of possible “transmissi­on” of lupus from mother to baby. Some drugs such as methotrexa­te may decrease libido”.

“Certain syndromes associated with lupus, such as antiphosph­olipid syndrome may prevent implantati­on or foetal death. This syndrome may also cause thrombosis clotting in blood vessels of many organs”.

The disease is uncommon in urban Nigeria. It constitute­s about five to eight per cent of all cases seen in a Rheumatolo­gy clinic. It is rarely seen however in rural Nigeria suggesting some environmen­tal factors as industrial pollution and motor vehicle pollution in urban areas”.

Asked, what is the treatment for the disease. He said, “Quite a lot of medication­s are available. Since lupus 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.

“Thus, the group of drugs called immune suppresant­s are deployed in different combinatio­ns. They include steroids, hydroxychl­oroquine, azathiopri­ne, mycophenol­ate mofetil, cyclophosp­hamide, cyclospori­ne, tacrolimus, dapsone and thalidomid­e”.

Adelowo disclosed that there are still some unmet needs in terms of treatment. “We have two new effective agents produced by biotechnol­ogy and directed at a particular form of white cells called B lymphocyte­s. These cells appear to be a major culprit in setting up the inflammati­on causing the damage to tissues. The two available drugs are rituximab and belimumab. However, any of the drugs mentioned are not to be self- administer­ed. The Rheumatolo­gist is trained to handle the administra­tion and adverse effects.

On how lupus can be prevented, he said. “Unfortunat­ely, there are no particular measures to prevent it, since those who are predispose­d to develop it will still have it. However, in families of those who have it, regular check of the tests called antinuclea­r antibody, if positive, will indicate that such persons may develop lupus at some time, or have manifestat­ions of lupus. Early detection will result in early treatment and prevention of internal organ affectatio­n. Otherwise, there are no known medication­s that will prevent it”.

He said there has been an increase in the number of SLE patients seen in Nigeria. This is due to such factors as an increasing awareness of lupus by doctors generally, increased awareness in the community, a significan­t rise in the number of rheumatolo­gists from just one in early 2000s to more than 50. This number is distribute­d in all the six zones of Nigeria, such that a rheumatolo­gist is just about 100 to150 kilometres away. There is also increasing teaching of this condition to medical students, who will end up practising in hospitals as doctors”, Adelowo said.

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