Spotlight: Systemic lupus erythematosus (SLE/Lupus)
Systemic lupus erythematosus (SLE), also commonly called lupus, is a chronic, systemic, autoimmune inflammatory condition, mainly affecting connective tissue. Lupus impacts multiple organ systems including the skin, muscles, joints, lungs, kidneys, central nervous system and blood.
The hallmarks of lupus are the production of large numbers of autoantibodies and circulating immune complexes that are deposited in various tissues and organs around the body.
Because lupus is a multi-system disease, individuals can present with often highly variable symptoms, sometimes making diagnosis challenging.
The classic hallmark of the disease is a “butterfly rash” with fever and joint pain, but this has certainly not been present in all of my patients with lupus. In fact, many have gone undiagnosed for years, essentially living with an invisible illness.
Other symptoms of lupus can include:
- cognitive impairment
- joint and muscle aches and pains
- mouth and nose ulcers
- poor circulation including Raynaud’s phenomenon and cold hands and feet
- inflammation of the tissue surrounding the heart and lungs
- changes in red and white blood cells on blood tests
- enlarged spleen
- nephritis and other changes to kidney function
It is interesting that unlike other autoimmune diseases that often go into a period of remission or dormancy during pregnancy, women with SLE can experience significant flares. It has been hypothesised that this is due to reduced hormonal clearance, however the exact mechanism remains unknown.
Like other autoimmune diseases, the exact aetiology of the disease is relatively unknown, however both genetic and epigenetic triggers are likely to be involved.
Environmental exposures to xenobiotics and heavy metals and reduced detoxification capacity may play a role. Certain medications have also been implicated in disease development. Other potential factors include reduced digestive function, food allergies/intolerances, and a defect in DHEA production.
Bacterial pathogens have been implicated including Mycobaceterium tuburculosis and Helicobacter pylori as well as viruses including Epstein Barr (glandular fever), parovirus, cytomegalovirus and other retroviruses. Microbiome imbalance including higher levels of gram-negative bacteria producing lipopolysaccharides (LPS) have also been implicated in disease onset.
What is now widely recognised is the role of the gut and immune system in disease development, therefore treating underlying gut and immune dysfunction is a core component of treatment.
There is no one test that can diagnose lupus. Diagnosis is based on a combination of clinical features and blood test abnormalities.
Conventional Medical Treatment
Treatment for lupus can vary from symptomatic treatment to strong medications to suppress the immune system and inflammatory processes, that can have significant side effects for many patients. The most commonly used are:
Prednisolone – This is a corticosteroid that suppresses the immune system and can have long term significant consequences including osteoporosis and cardiovascular disease. It is used when major organs are involved.
Methotrexate – This is a chemotherapeutic drug and immune suppressant that also impacts on cell division (hence its use in cancer). One of its key actions is to reduce folate metabolism, thereby affecting a detoxification process called methylation, that is essential for your health and wellbeing. Folic acid is often co-prescribed for this reason, but can often create more inflammation in those with genetic variants including MTHFR.
Hydroxychloroquine – This is an anti-malarial drug that has gained a lot of notoriety lately due to its potential role in the treatment of COVID. It acts by reducing the number of circulating immune complexes.
All immune suppressants carry a greater risk of developing serious infections and even cancer, so working with a Naturopath who can safely co-prescribe is essential.
Addressing the underlying drivers, which are unique to every individual, is key to successful treatment. However, the majority of people I work with have compromised gut health so this forms a key component of their treatment plan.
Naturopathic treatment focuses on diet and lifestyle interventions, alongside nutrients and herbs that are scientifically proven to exert an anti-inflammatory action and modulate (or balance) the immune system.
Whilst people often see a Naturopath in the hope of avoiding or minimising medication, it is important to know that I have also successfully worked with patients who take medication, to reduce side effects and symptoms and improve their quality of life.