Lupus (लुपस) Meaning in Nepali: SLE Symptoms, Tests and Treatment
By Dr. Krishna Adhikari, Consultant Rheumatologist
MBBS, MD (Internal Medicine), Fellowship in Clinical Rheumatology
Awaiting medical review: this new article has not yet been checked by Dr. Krishna Adhikari. It will be updated after his review.
Lupus (लुपस in Nepali), or systemic lupus erythematosus (SLE), is a long-lasting autoimmune disease: the immune system attacks the body's own healthy tissue. The inflammation this causes can affect the skin, joints, kidneys, blood cells and other organs. Lupus is not contagious, and with treatment, many people with lupus can manage the disease.
What is the meaning of lupus in Nepali?
In Nepali, lupus is written लुपस. Its full medical name is systemic lupus erythematosus (SLE); "systemic" means it can affect many parts of the body.
Because lupus often causes joint pain, it is one of the conditions grouped under bath rog (बाथ रोग) in everyday Nepali. But lupus can affect any part of the body, not only the joints.
Who gets lupus, and what causes it?
Anyone can get lupus. The US National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) states that women get it about nine times more often than men, most often between the ages of 15 and 45, and that it is more common in people of Asian descent. A family member with lupus or another autoimmune disease may make it more likely.
The cause is unknown. Genes play a part, and viral infections, sunlight, certain medicines and smoking may trigger it. It is not your fault.
What are the first signs and symptoms of lupus?
The Lupus Foundation of America says there is no single first sign, and early signs vary widely. NIAMS and the NHS list:
Extreme tiredness that rest does not relieve.
Painful, swollen joints and morning stiffness.
A "butterfly" rash across the nose and cheeks, or rashes after being in the sun.
Fever and hair loss.
Mouth or nose sores, often on the roof of the mouth, which usually do not hurt.
Fingers and toes turning white, blue-purple or red with cold or stress (Raynaud's phenomenon).
Swollen glands, and swelling of the legs or around the eyes.
Chest pain when breathing deeply, headaches and belly pain.
Kidney problems and low blood counts, found by urine and blood tests.
Symptoms come and go: worse periods are called flares, calmer ones remission. Other conditions can cause similar symptoms, so they do not always mean lupus.
Is lupus a serious disease?
It can be. The NHS describes three levels: mild (joint and skin problems, tiredness), moderate (inflammation of other parts of the body, such as the lungs, heart and kidneys) and severe (damage to the heart, lungs, brain or kidneys, which can be life-threatening).
Can you live a long life with lupus?
The American College of Rheumatology states that most people with lupus can live normal lives, and that people with lupus are living longer as treatment improves. It advises taking medicines as prescribed and seeing your rheumatologist regularly.
How does lupus affect the kidneys (lupus nephritis)?
Lupus nephritis is kidney inflammation caused by lupus. The Lupus Foundation of America explains that it can stop the kidneys working. Early on there may be no symptoms; later it can cause:
Swelling, usually of the feet, ankles, legs or face.
Foamy urine.
Passing urine more often, especially at night.
High blood pressure.
Because it can be silent, people with lupus need regular urine tests (for blood and protein) and kidney blood tests, and sometimes a kidney biopsy. Regular use of painkillers called NSAIDs, such as ibuprofen, can damage the kidneys; if you have kidney problems, ask your doctor what to take for pain.
How is lupus diagnosed?
Lupus can be hard to diagnose because its symptoms come and go and can look like other diseases. NIAMS states that no single test diagnoses lupus. Your doctor puts together your symptoms (including past ones), family history, an examination, blood and urine tests, and sometimes a skin or kidney biopsy.
The ANA test (ANA by IFA)
The ANA (antinuclear antibody) test is a blood test for antibodies that attack the centre (nucleus) of your own healthy cells. NIAMS calls it a sensitive test for lupus: almost all people with lupus have a positive ANA.
"ANA by IFA" on a report names the standard method, the immunofluorescence assay, in which antibodies from your blood that stick to human cells are made to glow under a microscope. The report gives a titre (a dilution such as 1:80 or 1:160, showing how concentrated the antibodies are) and a pattern, such as speckled. The American College of Rheumatology notes that some laboratories report any titre above 1:160 as positive. Laboratories use their own ranges; read the range printed on your report.
A positive ANA does not by itself mean lupus. According to the American College of Rheumatology, up to 15% of completely healthy people have a positive ANA, and only about 11 to 13% of people with a positive ANA have lupus or another autoimmune or connective tissue disease. Positive results become more common with age, and some medicines, viral infections and other conditions can cause them. Your doctor reads it together with your symptoms. A negative ANA makes lupus less likely, although MedlinePlus notes that it does not completely rule out an autoimmune disorder. Tell your doctor about your medicines before the test, but do not stop any unless told to.
Other tests for lupus
Doctors may also order (NIAMS, MedlinePlus):
Anti-dsDNA (anti-double-stranded DNA), anti-Smith and antiphospholipid antibodies, when the ANA is positive, to help show whether it is lupus.
Complement (C3 and C4), immune proteins that may be low in lupus; the test can also show how well treatment is working.
Complete blood count, for low red cells, white cells and platelets.
Kidney blood tests, and urine tests for protein.
Blood tests for inflammation, ESR and CRP, are explained in our ESR and CRP guide. Your doctor will tell you which tests you need; ask the laboratory for its current price and any preparation.
How is lupus treated?
Lupus is long-lasting, and at present no treatment removes it for good. But NIAMS notes that treatments have improved dramatically, and remission may be possible. Most people are treated by a rheumatologist, sometimes with a kidney or skin specialist. The goals are to control symptoms and flares, prevent or slow organ damage, and improve quality of life.
Medicines depend on how severe the lupus is and which organs are involved. These are groups a doctor may prescribe, not advice to take anything:
Antimalarial medicines such as hydroxychloroquine, which NIAMS says help fatigue, joint pain, skin rashes and lung inflammation, and may prevent flares.
Anti-inflammatory painkillers (NSAIDs) for pain and fever (see the kidney warning above).
Corticosteroids (steroids), as tablets, creams or injections, at the lowest dose that works.
Immunosuppressant and biologic medicines, which calm the immune system and are sometimes used for severe lupus.
Regular check-ups watch both the disease and side effects. Never stop a lupus medicine without speaking to your doctor. Research has not clearly shown that special diets, supplements or homeopathy help lupus, and some herbs and supplements interfere with medicines, so ask your doctor first.
How does lupus affect daily life?
Living with lupus can be hard, physically and emotionally; tell your doctor if you feel low. NIAMS notes that most people with mild lupus, or lupus in remission, can usually do the same activities as before. NIAMS and the NHS advise:
Protect yourself from the sun, which can trigger a flare: a hat, long sleeves and high-factor sunscreen (the NHS suggests at least factor 50) whenever you go outside.
Learn the warning signs of a flare, such as more tiredness, joint swelling, rash or fever.
Do not smoke. Smoking makes lupus worse.
Eat a balanced diet and lower stress.
Lupus and pregnancy
NIAMS states that most women with lupus can have healthy pregnancies if the disease is under control. But lupus can cause pregnancy complications, and some lupus medicines are not compatible with pregnancy, so plan ahead with your rheumatologist and never stop a medicine on your own. See our article on lupus and pregnancy.
लुपस (SLE): नेपालीमा संक्षेप
लुपस, जसको पूरा नाम सिस्टेमिक लुपस एरिथेमाटोसस (SLE) हो, लामो समयसम्म रहने अटोइम्युन रोग हो। यसमा शरीरको रोग प्रतिरोधात्मक प्रणालीले आफ्नै स्वस्थ तन्तुलाई आक्रमण गर्छ, जसले छाला, जोर्नी, मृगौला, रगत र अन्य अंगमा सुजन (इन्फ्लामेसन) ल्याउन सक्छ। लुपस सरुवा रोग होइन। यो जोसुकैलाई हुन सक्छ, तर पुरुषभन्दा महिलामा करिब नौ गुणा बढी देखिन्छ, प्रायः १५ देखि ४५ वर्षको उमेरमा।
मुख्य लक्षणहरू: आराम गर्दा पनि नजाने थकान, जोर्नी दुख्ने र सुन्निने, नाक र गालामा पुतलीको आकारको दाग, घाममा बसेपछि छालामा दाग आउने, ज्वरो, कपाल झर्ने, र मुख वा नाकमा घाउ। लक्षणहरू कहिले बढ्छन्, कहिले कम हुन्छन्।
मृगौलामा असर (लुपस नेफ्राइटिस) सुरुमा थाहा नहुन सक्छ, त्यसैले नियमित पिसाब र रगत जाँच गर्नुपर्छ। ANA जाँच पोजिटिभ आउँदैमा लुपस भएको हुँदैन; धेरै स्वस्थ मानिसमा पनि ANA पोजिटिभ आउन सक्छ। डाक्टरले लक्षण, शारीरिक जाँच र अन्य परीक्षणका रिपोर्ट हेरेर निदान गर्छन्।
उपचारले लक्षण नियन्त्रण गर्न र अंगलाई क्षति हुनबाट जोगाउन मद्दत गर्छ। डाक्टरको सल्लाहबिना औषधि नछोड्नुहोस्। घाममा निस्कँदा टोपी र लामो बाहुलाको लुगा लगाउनुहोस्, र सनस्क्रिन लगाउनुहोस्। सास फेर्न नसकेमा, धेरै कडा दुखाइ भएमा वा हार्ट अट्याक भएजस्तो लागेमा तुरुन्तै नजिकको अस्पतालको इमर्जेन्सीमा जानुहोस्।
When to see a rheumatologist
The NHS says lupus is better managed if it is found and treated early. See a rheumatologist if you have joint pain or swelling with a rash, fever, mouth sores, hair loss or lasting tiredness, or a positive ANA report you are unsure about. If you have lupus, report new or worsening symptoms, changes in your urine, or new swelling of your hands or feet, which the American College of Rheumatology says can point to kidney problems. Joint pain has many causes; our guides to rheumatoid arthritis and ankylosing spondylitis explain two others.
Emergency: if you cannot breathe, are in severe pain or think you are having a heart attack, Cleveland Clinic advises going to a hospital emergency department straight away.
Rheumatology care in Kathmandu Valley
Rheumatology care at Tulsi Multi Speciality Clinic is provided by Dr. Krishna Adhikari, consultant rheumatologist and Lecturer in Internal Medicine at Patan Academy of Health Sciences (Patan Hospital), NMC No. 13049. He consults Sunday to Friday from 4:00 PM at AVM Chowk, Manbhawan, Lalitpur-5, Kathmandu Valley. See our rheumatology service and Dr. Krishna Adhikari's profile, book an appointment, or call +977-1-5914294. This article is general information, not a substitute for a consultation.
Sources
Rheumatology care at Tulsi Multi Speciality Clinic · Dr. Krishna Adhikari, consultant rheumatologist
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