In December 2023, renowned Hong Kong actress Kathy Chow died at the age of 57. A leaked document claimed that she had Systemic Lupus Erythematosus (SLE) and high blood pressure (hypertension). In light of this tragic event, an experienced Rheumatologist, Dr Annie Law, will be demystifying SLE, the autoimmune condition that Chow allegedly suffered from, in the hope of promoting a better understanding of SLE.
SLE’s definition and early warning signs
SLE is a chronic autoimmune condition that occurs when your body’s immune system targets its own tissues and organs. SLE can come with certain early warning signs. Some patients may develop symptoms of fatigue, weight loss, unexplained fever, rashes or hair loss from weeks to months before the onset of the disease.
Causal and risk factors for SLE
The exact cause of lupus is not fully known. However, it is believed to result from a combination of genetic, environmental and hormonal factors.
In particular, Asian women are typically more prone to developing SLE relative to Caucasian counterparts due to the following risk factors:
- Asian descent: Asians are at a higher risk of getting SLE and tend to have more severe disease than Caucasians, because of genetic predisposition and environmental factors.
- Female: Similarly, women are more likely than men to have SLE due to gene variants on the X chromosomes and the potential hormonal effect of oestrogen.
Consequences of SLE on the body
Individuals with SLE produce autoantibodies which target healthy cells, tissues and organs, causing inflammation. SLE typically causes joint pain, skin rash, hair loss, oral or nasal ulcers and Raynaud’s phenomenon (a disease whereby fingers or toes turn white or blue when exposed to cold or stress). If left untreated, it may cause organ damage to the kidneys, neurological system, heart, lungs and gastrointestinal tract.
Apart from causing chronic inflammation and potential organ damage, SLE also increases the risk of developing cardiovascular disease, hypertension, diabetes and obesity compared to individuals without SLE. These heightened risks are attributed to the disease itself and prolonged use of steroids, which accelerates the development of atherosclerosis (build-up of fats, cholesterol and other substances in and on the blood vessel walls).
Studies have shown that individuals with SLE face a two-fold increase in likelihood of developing hypertension, with contributing factors including obesity, kidney disease and prolonged use of steroids.
Prevention of SLE
Environmental factors, including infections, certain medications, sunlight, smoking and stress, can trigger lupus. Thankfully, there are lifestyle tips that help keep SLE at bay. It is important to lower your risk of developing SLE by applying sunscreen, wearing protective clothing (long-sleeve shirts, sunglasses and hats) that reduces excessive sunlight exposure, refraining from smoking and managing stress effectively.
Treatment and management of SLE
While there is no cure for SLE, effective treatments control disease activity by reducing inflammation and preventing organ damage. SLE patients can still lead normal, healthy lives with appropriate care from a rheumatologist.
The following practices can help individuals with SLE better manage their condition:
- Lifestyle modifications: maintaining a healthy lifestyle, which includes regular exercise, a balanced diet, stress management and sufficient sleep, can help to reduce the risk of lupus flares and enhance overall well-being.
- Regular monitoring: close follow-up with your rheumatologist is essential for ongoing care and medication adjustments.
- Preventive measures: vaccinations are recommended to reduce the risk of infections, as some individuals with SLE are more susceptible to being infected.
- Guarding against cardiovascular diseases: it is advisable to follow dietary measures to improve your lipid profile (choose unsaturated fats available in olive oil, avocados, nuts and seeds, as well as limit saturated fats from sources like red meat, full-fat dairy and processed foods) and abstain from smoking. Some other measures to reduce the risk of cardiovascular disease include:
- Antimalarial drugs such as hydroxychloroquine, that are often prescribed to SLE patients, are known to reduce the risk of clot and cholesterol profiles, lower the chance of organ damage and increase survival in SLE patients.
- Use of lipid-lowering agent to control cholesterol levels.
- Staying compliant with medications to minimise disease flares with the lowest possible glucocorticoid dose.
When to see a rheumatologist
Dr Annie Law, Senior Consultant Rheumatologist and Medical Director
If you experience symptoms associated with SLE, like fatigue, fever, photosensitive rash and joint pain, it is advisable to see a rheumatologist. Rheumatologists are doctors who specialise in treating and managing autoimmune diseases like SLE. They will take a detailed history, examine you and conduct appropriate tests to confirm the diagnosis of SLE.
You can book an appointment with Dr Annie Law, an experienced Senior Consultant Rheumatologist and Medical Director at Asia Arthritis & Rheumatology Centre (https://aarc.sg/), to address your SLE concerns.
Images: Shutterstock and Asia Arthritis & Rheumatology Centre