Insights from Dr. Vishad Vishwanath (Rheumatologist & Immunologist)

Every year, May 10 is observed as World Lupus Day to raise awareness about lupus, a chronic autoimmune disease that affects thousands of people worldwide. Despite being a serious condition, lupus is still not widely understood by the public.

In a detailed interview, Dr. Vishad Vishwanath explained the nature of Systemic Lupus Erythematosus (SLE), its symptoms, diagnosis, treatment, and the importance of long-term care and emotional support.

What is Systemic Lupus Erythematosus (SLE)?

Systemic Lupus Erythematosus, commonly called SLE or lupus, is an autoimmune disease in which the immune system mistakenly attacks the body’s own cells and tissues. Unlike common forms of arthritis that mainly affect joints, SLE can involve multiple organs throughout the body.

Dr. Vishad describes SLE as the “prototypical autoimmune disease” because it can affect almost any organ system. The disease is considered rare, with an estimated prevalence of around 1 in 10,000 people.

SLE primarily affects young women, especially between the ages of 15 and 45 years. Although men can also develop lupus, severe disease manifestations are often seen more commonly in male patients.

Why Does Lupus Affect Women More?

According to Dr. Vishad, two major factors contribute to the higher incidence of SLE in women.

1. Genetic Factors

Women have two X chromosomes (XX), while men have one X and one Y chromosome (XY). Certain genes involved in immune regulation are present on the X chromosome, which may increase susceptibility to autoimmune diseases in women.

2. Hormonal Influence

The female hormone estrogen also influences immune system activity. This hormonal effect may contribute to stronger immune responses and increased autoimmune tendencies.

The combination of genetic and hormonal influences is believed to play a major role in the higher occurrence of lupus among women.

Why is SLE Called the “Great Imitator”?

One of the most challenging aspects of lupus is that its symptoms can resemble many other diseases. Because SLE can affect almost every organ system, it is often referred to as the “Great Imitator.”

Symptoms mentioned by Dr. Vishad include:

• Hair loss
• Eye problems and vision impairment
• Mouth ulcers
• Skin rashes
• Photosensitive rashes triggered by sunlight
• Persistent unexplained fever
• Joint pain and inflammation
• Lung involvement
• Heart involvement
• Kidney disease

Since these symptoms overlap with many other medical conditions, lupus is often considered in the differential diagnosis of patients with unexplained clinical symptoms.

Common Signs That Help in Diagnosis

In some patients, diagnosis becomes easier when classic features are present.

One of the most recognized signs is the butterfly rash (malar rash) that appears across the cheeks and nose. Dr. Vishad explains that this rash becomes worse after sunlight exposure and is seen in around 60–70% of patients.

Other important findings include:

• Hair loss with characteristic patterns
• Low white blood cell count (especially lymphocytes)
• Autoimmune destruction of red blood cells causing anemia
• Low platelet counts leading to bleeding tendency

However, not all patients present with obvious symptoms. Some may only have prolonged fever, mild kidney disease, or fluctuating blood abnormalities, which can delay diagnosis.

How is SLE Diagnosed?

Diagnosis requires a combination of clinical examination and laboratory investigations.

Blood Tests

Doctors commonly evaluate:

• Complete Blood Count (CBC)
• Anemia
• Leukopenia
• Thrombocytopenia

Urine Tests

Urine examination helps identify kidney involvement through:

• Protein in urine (proteinuria)
• Blood in urine (hematuria)

Immunological Tests

Specific autoimmune markers include:

• ANA (Antinuclear Antibody) test
• Anti-dsDNA antibody test, which is highly specific for SLE

Kidney Biopsy

When kidney involvement is suspected, a kidney biopsy may be performed to confirm diagnosis and assess disease severity.

What Causes Lupus?

Dr. Vishad explains that lupus does not occur because of a single trigger. Instead, it develops due to a combination of genetic susceptibility and environmental factors.

Important triggers discussed in the interview include:

• Excessive ultraviolet (UV) sunlight exposure
• Viral infections such as Epstein-Barr Virus (EBV) and CMV
• Certain medications that can cause drug-induced lupus

These triggers can disturb the immune system and lead to the formation of autoimmune complexes that attack body tissues and organs.

Early Symptoms of Lupus

Fatigue and persistent tiredness are among the earliest and most common symptoms of SLE. However, these symptoms are nonspecific and may occur in many illnesses.

Joint pain and skin manifestations often help doctors differentiate lupus from other conditions. Dr. Vishad emphasizes that diagnosis is based on both symptoms and laboratory findings together.

Treatment Options for SLE

The primary goal of treatment is to control immune system overactivity while avoiding excessive immunosuppression.

Hydroxychloroquine

Hydroxychloroquine has been used since the 1950s and continues to be a cornerstone treatment for SLE. It remains one of the most important FDA-approved medications for lupus.

Corticosteroids

Steroids were previously used in very high doses, but modern treatment strategies aim to use the lowest effective dose because of long-term side effects.

Immunosuppressive Medicines

Other medications used include:

• Cyclophosphamide
• Mycophenolate mofetil
• Tacrolimus

Treatment decisions depend on disease severity and which organs are affected, especially the kidneys.

Improvement in Survival and Prognosis

Dr. Vishad highlights the major improvement in lupus care over the decades.

In the 1950s, the five-year survival rate was only around 50–60%. With better diagnostic methods and newer treatment approaches, survival has significantly improved to around 75–80%.

Advances in medications and better disease monitoring continue to improve long-term outcomes for patients.

Lifestyle and Environmental Precautions

One of the most important environmental factors in lupus is sunlight exposure.

Patients are advised to avoid direct sunlight, especially between 10 AM and 3 PM, because ultraviolet rays can worsen disease activity and skin symptoms.

Other important lifestyle measures include:

• Maintaining a healthy diet
• Stress management
• Weight control
• Proper management of diabetes and other comorbidities

These measures help reduce complications and improve overall health.

Vaccinations and Infection Prevention

People with lupus are more vulnerable to infections because of immune dysfunction and immunosuppressive treatments.

Dr. Vishad recommends important adult vaccinations such as:

• Influenza vaccine
• Hepatitis B vaccine

Some vaccines may need careful timing depending on the patient’s immune status and treatment.

Can Lupus Go Into Remission?

Remission in lupus means disease activity is well controlled with minimal or no symptoms.

Dr. Vishad explains two forms of remission:

Clinical Remission

No active symptoms or abnormal physical findings.

Drug-Free Remission

A small number of patients may remain symptom-free without medications for certain periods, but this is uncommon.

He strongly emphasizes that patients should never stop medications abruptly and must continue regular follow-up.

Pregnancy and Lupus

Women with well-controlled lupus can have successful pregnancies.

Important points discussed in the interview include:

• Disease should remain well controlled for at least six months before conception
• Pregnancy-safe medications must be used
• Drugs like mycophenolate should be stopped and replaced before pregnancy
• Anti-Ro/SSA and Anti-La/SSB antibodies should be monitored because they may affect the baby’s heart
• Anti-cardiolipin antibodies can increase the risk of pregnancy loss and preeclampsia

With proper care and monitoring, nearly 80% of pregnancies can have successful outcomes.

Is Lupus Hereditary?

Lupus is not contagious, but genetics do play a role.

First-degree relatives of lupus patients have a higher risk compared to the general population. However, because lupus itself is rare, the overall absolute risk still remains relatively low.

Dr. Vishad advises awareness and monitoring among family members with a history of SLE.

Importance of Regular Follow-Up

Continuous monitoring is essential in lupus management.

Patients may require frequent follow-up for:

• Kidney involvement
• Blood count abnormalities
• Disease flare-ups
• Medication side effects

Monitoring usually includes clinical examination, blood tests, urine tests, and sometimes complement level testing.

The frequency of follow-up depends on disease activity and severity.

Emotional Support and Quality of Life

Since lupus mainly affects young adults during important stages of education, career building, and family life, emotional and social support becomes extremely important.

Dr. Vishad emphasizes that many fears and misconceptions surround lupus. Family encouragement and psychological support help improve treatment adherence and overall well-being.

He also stresses that lupus should not prevent individuals from pursuing education, careers, or family responsibilities.

With proper treatment and a positive outlook, patients can lead near-normal lives.

Final Message from Dr. Vishad Vishwanath

Dr. Vishad concludes with a reassuring message for patients and young people living with lupus.

SLE is a chronic long-term disease, but it is manageable with consistent treatment, regular follow-up, and lifestyle modifications. Treatment should be viewed as a support system that helps patients continue living meaningful and productive lives.

He encourages patients to move forward with confidence, continue their education and careers, and approach life positively while staying committed to medical care.