October 2012, Volume 62, Issue 10

Student's Corner

Systemic Lupus Erythematosus: To suffer or not to suffer?

Madam, autoimmune diseases are a class of disorders which result from a loss of self recognition by the immune system. They are more common in females and include conditions such as Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis. They are responsible for considerable morbidity in the western world.1 Up to 8% of the US population (22 million people) is affected by one of these disorders.2 Although the epidemiological data for Asia and especially Pakistan is scarce, their prevalence rate in this region is comparable to that of the West.3
Systemic Lupus Erythematosus (SLE) is characterized by widespread tissue damage in the heart, lungs, skin, joints, liver, blood vessels, nervous system and kidneys. Complications include skin problems (rashes), glomerulonephritis, interstitial fibrosis of lungs and recurrent abortions with a propensity of complete heart block in newborns. Diagnosis is based on the history, examination, and a presence of Anti Nuclear Antibodies (ANAs), anti-dsDNA antibodies and/or anti-Smith Antibodies in the serum.4 Treatment is palliative, with immunosuppressives (eg azathioprine, methotrexate and cyclophosphamide), corticosteroids (eg prednisone) and hydroxychloroquine making the frontline therapy.5
Two things are of concern in our setup:
1) Majority of the general population does not consider autoimmune diseases as a separate entity, but rather classifies them as musculoskeletal disorders. Most patients that have signs or symptoms of SLE (or other autoimmune disease) either opt for self-medication, or go to a local hakeem or a general practitioner, who often misdiagnoses the disease. Wide-scale programmes (with Media support) are needed to promote awareness regarding this set of disorders in the public.
2) Laboratory tests for the detection of antibodies against various self-antigens are either not available at most labs, or are too expensive for the general public. Special rheumatological centers should be setup for prompt diagnosis and treatment.
Therefore, the government should take appropriate steps to create awareness among the people, as well as reduce the suffering that these diseases cause.

Asfandyar Sheikh,1 Syed Hassan Abbas Naqvi,2 Syed Hasan Shiraz Naqvi,3 Kainat Sheikh4
4th Year Students,1,2 Final Year Student,3 Dow Medical College, First Year Student, Sindh Medical College,4 Dow University of Health Sciences, Karachi.
Corresponding Author: Asfandyar Sheikh.
Email: asfandyarsheikh@gmail.com

References

1. Cooper GS, Stroehla BC. The epidemiology of autoimmune diseases. Autoimmun Rev 2003; 2: 119-25.
2. Dana Cassell, Noel R. Rose. The Encyclopedia of Autoimmune Diseases, 2003.
3. Jakes RW, Bae SC, Louthrenoo W, Mok CC, Navarra SV, Kwon N. Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: prevalence, incidence, clinical features, and mortality. Arthritis Care Res (Hoboken) 2012; 64: 159-68.
4. Egner W. The use of laboratory tests in the diagnosis of SLE. J Clin Pathol 2000; 53: 424-32.
5. Miescher PA. Treatment of systemic lupus erythematosus. Springer Semin Immunopathol 1986; 9: 271-82.

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