Lupus is a chronic autoimmune disease that can affect many different parts of the body. It begins when antibodies attack normal tissue, causing chronic inflammation and tissue damage. Dr Daman Langguth is an immunologist and Head of the Immunology Department at Sullivan Nicolaides Pathology, he explains that lupus can be hard to diagnose because it has many symptoms that are often mistaken for symptoms of other diseases.
“Lupus varies quite widely in prevalence across ethnic backgrounds. The overall frequency in Australia is around 1 in 2,000 and around 90% of those affected are women. Lupus can start as a child; however, the majority of people develop the condition between the age of 15 and 45. Limited data suggests that Aboriginal people have an increased risk of Lupus – we don’t know the exact frequency, but we know that it is high – and they seem to get more severe disease.
“Different people have different symptoms, and one person may have different symptoms at different times. Lupus can present with inflammation of many areas of the body including the muscles, joints, skin, kidneys, heart and rarely the brain. Often people will be experiencing symptoms for a significant time before they are diagnosed because the symptoms are often vague, such as fatigue, making the investigation difficult. In Australia skin lupus (limited to the skin) is more common because it is photosensitive, meaning it is triggered by UV light,” said Dr Langguth.
The exact mechanism for lupus is not known. Many scientists believe that lupus develops in response to a combination of factors both inside and outside the body, including hormones, genetics, and environment.
“There is no single test that can be used to diagnose lupus and it may take some time to reach a diagnosis. We use an Antinuclear antibody (ANA) test to screen for the disease but that can only tell if you don’t have lupus. Around 1 in 10 women in their 20’s will be ANA positive, but the frequency of lupus is 1 in 2000. That means only 1 in 200 people who have a positive ANA test will actually have lupus. A holistic approach is therefore required in order to reach a diagnosis. This includes a combination of blood and urine tests, signs and symptoms, and physical examination findings,” said Dr Langguth.
There is currently no cure for lupus. The aim of treatments is to control symptoms and limit the amount of the damage the disease does to the body. These treatments must be individualised, taking account of the severity of the disease.
“Around 15 years ago, a drug called mycophenolate which was developed for organ transplants, was adapted for the treatment of lupus and that was a big step forward. However, since then multiple other drug trials have failed. There are currently many lupus trials going on across the world with various medications, but no one can feel confident to say these are going to work for the majority of people and indications. Although this is the case, most people are able to manage the disease and enjoy a good quality of life,” said Dr Langguth.