Diagnosing lupus can be difficult. There are a wide range of different complaints such as fever, weakness, weight loss, hair loss, abdominal pain, anemia, pain in the joints of the hands and feet, and sometimes pregnancy loss, which are not specific to lupus.
– Rashes – butterfly-like skin rash spreading from the nose to the cheeks (malar rash), rash on the skin with sunlight (photosensitivity), discoid rash, diffuse erythematous skin rashes,
– Raynoud’s phenomenon ( a vascular disorder that develops in the extremities of the body such as the fingers and toes under cold or stress, leading to paleness, bruising and then redness),
-Wounds in the mouth,
-Arthritis; morning stiffness and pain, swelling or arthropathy (Jacood arthropathy) especially in small joints
– Fluid increase due to inflammation in the lung and heart membrane (pleurisy, pericarditis); chest pain with or without breathing.
-Kidney; presence of blood or protein in the urine or impaired kidney function, development of edema.
-Neurological problems; such as seizure, stroke (stroke) or psychosis.
-Abnormal blood tests: decrease in blood cells (erythrocyte, platelet, leukocyte, lymphocyte), anti-nuclear antibody (ANA) positivity, anti-dsDNA, anti-Sm, anti-phospholipid antibody or false syphilis test positivity .
Antiphospholipid antibodies; They are antibodies found in a syndrome with recurrent pregnancy loss and/or vascular coagulation. The presence of these antibodies in patients with lupus is important both to aid in the diagnosis of lupus and to show whether antiphospholipid syndrome is accompanied by it.
Laboratory tests:
Complete blood count, reticulocyte count, lactate dehydrogenase, direct and indirect Coombs test, protein in urine (500mg or more in 24-hour urine) and active cellular casts in urine (erythrocyte and leukocyte casts), ANA, anti-dsDNA, anti-Sm, antiphospholipid antibodies, complement levels in addition to the tests to be performed in the first place, if necessary, for the organs and tissues involved; Further examinations such as kidney biopsy and brain imaging can also be performed.
Treatment of lupus:
There is no treatment to cure lupus completely. However, great improvement is achieved with treatment. Lupus does not progress in a similar way in every patient. While it progresses with mild skin and joint involvement in some of the patients, it may go away with severe organ and system involvement in some. For this reason, it is necessary to arrange the treatment with the meticulousness of a tailor specific to the patient.
– Non-steroidal anti-inflammatory drugs (such as naproxen, diclofenac, ibuprofen, indomethacin); It can be used for pain, fever, and joint inflammation. Side effects such as stomach bleeding and impaired kidney function should be considered; Especially the lupus patient should not use these drugs unless the doctor prescribes them.
-Anti-malarial (malaria) drugs; Hydroxychloroquine (plaquanil) is good for fatigue, rash, joint pain and mouth sores due to lupus. It can prevent abnormal blood clotting. It is recommended for almost every lupus patient to use it unless there is an obstacle.
-Corticosteroids; In patients with lupus with severe or life-threatening involvement (such as kidney, lung, heart, blood, and central nervous system), stronger treatments should be initiated. For this reason, high-dose corticosteroid therapy is preferred in these patients due to its rapid and powerful effects in the early period. Depending on the course of the disease, it can also be used in lower and moderate doses.
Immunosuppressive drugs; They provide control of the disease by suppressing the immune system. These; azathioprine (imuran), cyclophosphamide (endoxan), cycloporin and mycophenolate mofetil.
-Biological treatments; only belimumab (benlysta) is approved by the FDA (Food and Drug Administration) for use in some lupus patients. Although not FDA approved, rituximab can be used in resistant lupus cases.
Every treatment has risks and benefits. For this reason, a treatment plan is made by the relevant specialist physician, considering the benefit-loss ratios.
