Lupus

Lupus (systemic lupus erythematosus — SLE) is a chronic autoimmune disease where the immune system attacks many parts of the body. It mostly affects young women (roughly 9× more than men), often in the 20s and 30s, and is more common and more severe in South Asians than in Europeans. It is serious but treatable — and early diagnosis changes the outcome.

Common features

• Fatigue — often the earliest and most disabling symptom.
• Joint pain and swelling, mostly hands, wrists, knees.
• Skin: butterfly-shaped rash across cheeks, photosensitive rashes, discoid patches, mouth ulcers, hair loss.
• Kidney involvement (lupus nephritis) — more common and severe in Indian lupus; often silent, needing urine + kidney tests.
• Blood: anaemia, low platelets, low white cells.
• Heart and lungs: pericarditis, pleurisy.
• Neurological: headaches, strokes, seizures, mood changes.
• Pregnancy: miscarriage, pre-eclampsia, antiphospholipid syndrome — careful planning improves outcomes.

Diagnosis

• Clinical pattern + blood tests — ANA, anti-dsDNA, anti-Sm, complement (C3, C4), urine test.
• Diagnosis and ongoing care by a rheumatologist, with a nephrologist if kidney involved.
• Takes time — lupus is a mosaic disease; symptoms build up over months and years.

Treatment — the pillars

• Hydroxychloroquine — given to almost everyone with lupus; reduces flares and improves survival. Needs annual eye check.
• Short courses of steroids for flares; long-term steroid use is kept to the lowest possible dose.
• Immunosuppressants — for serious disease, especially kidney involvement.
• Biologics — several now available in India for refractory or severe disease.
• Sun protection — daily broad-spectrum sunscreen, hats, clothing — sunlight triggers flares.
• Vaccines (flu, pneumococcal, HPV, COVID, Hep B, tetanus) — kept up to date while disease is quiet.

Pregnancy planning

• Plan pregnancy during a quiet phase (at least 6 months stable).
• Continue hydroxychloroquine; switch other immunosuppressants to safe alternatives pre-conception under specialist care.
• Check antiphospholipid antibodies; anti-Ro/La for neonatal lupus risk.
• High-risk pregnancy care — joint rheumatologist + obstetrician + paediatrician team.

See a doctor urgently

• New chest pain, breathlessness, severe headache, seizure, sudden weakness.
• Dark or frothy urine, leg swelling — lupus nephritis flare.
• Fever with chills — infection risk is high on immunosuppressants.
• Severe flares often start subtly — don't delay.

Avoid

• Unregulated Ayurvedic/herbal "lupus cures" — several have caused liver failure or steroid dependency.
• Stopping hydroxychloroquine because "I feel fine" — strong association with flares.
• Skipping sunscreen.