Systemic Lupus Erythematosus (SLE) is an auto-immune disorder which affects many organs but more particularly the Skin, Brain, Kidneys and Joints. Auto-immunity in brief means that our body’s defense system (immune system) whose primary function is to protect us from external attacks [bacteria, virus] conversely attacks the body itself. It develops a short term/long term inability to distinguish between diseased and healthy tissue leading to the degeneration/complications of the entity it attacks. SLE causes long-term (chronic) inflammation of affected organs leading to degradation in overall quality of life.
SLE is much more common in women than men. It may occur at any age, but appears most often in people between the ages of 10 and 50. African Americans and Asians are affected more often than people from other races. The underlying causes with auto-immunity are unknown. Genetic dispositions, Heredity or simple evolutionary mechanism of nature can be evaluated. SLE may also be caused by certain drugs. known as Drug-induced Lupus Erythematosus
SLE may affect multiple or singular organs and hence symptoms may be chronic and acute. Of Acute symptoms almost everyone with SLE suffers from joint pain and swelling , the frequently afflicted joints being Fingers, wrist Elbows and knees. Another common symptom of diagnostic aid is an typical Skin rash resembling an “butterfly” which comes over the cheeks and bridge of the nose. This affects about half of people with SLE. The rash gets worse in sunlight. The rash may also be widespread. Other acute symptoms as follows
- Chest pain when taking a deep breath
- Fever with no other cause
- General discomfort, uneasiness, or ill feeling (malaise)
- Hair loss
- Mouth sores
- Sensitivity to sunlight
- Swollen lymph nodes
Apart from this symptoms may develop depending on which organ SLE affects. This may have acute manifestations but generally develop over a period of time requiring separate medical management of that particular organ in addition to overall treatment of SLE
Brain and nervous system: Headaches, Numbness, Tingling, Seizures, Vision problems, Personality changes
Digestive tract: Abdominal pain, Nausea, and Vomiting
Heart: Abnormal heart rhythms (Arrhythmias)
Lung: Coughing up blood and Difficulty in breathing
Skin: Patchy skin color, Fingers that change color when cold (Raynaud’s phenomenon). Some patients may only exhibit skin symptoms. This is called Discoid Lupus.
Auto immune disorders are difficult to diagnose in terms of Pin pointing a particular ailment. The management superficially being the same, correct labeling is required when tackling complications. For SLE it is a general rule to confirm its diagnosis if the patient has at least 4 out of the 11 typical signs of disease. These 11 signs are a combination of physical and pathological examinations which aid in diagnostics
- Malar (over the cheeks of the face) butterfly rash
- Discoid skin rash (patchy redness with hyperpigmentation and hypopigmentation that can cause scarring)
- Photosensitivity (skin rash in reaction to sunlight [ultraviolet light] exposure)
- Mucous membrane ulcers (spontaneous sores or ulcers of the lining of the mouth, nose, or throat)
- Arthritis (two or more swollen, tender joints of the extremities)
- Pleuritis or pericarditis (inflammation of the lining tissue around the heart or lungs, usually associated with chest pain upon breathing or changes of body position)
- Kidney abnormalities (abnormal amounts of urine protein or clumps of cellular elements called casts detectable with a urinalysis) [Lupus Nephritis or SLE of Kidney, is mostly confirmed by a kidney biopsy.]
- Brain irritation (manifested by seizures [convulsions] and/or psychosis, referred to as Lupus Cerebritis)
Blood-count abnormalities:Low white blood count (WBC) or red blood count (RBC), or platelet count on routine complete blood count testing)
Antibody Testing and Inflammatory paramaters:
- Antinuclear antibody; positive ANA antibody testing is most commonly seen and is of high diagnostic value
- CBC, ESR, C Reactive Protein , these parameters are important in tracking inflamatory response and generally show anamolies serving of high Diagnostic value along with ANA
- Apart from this other abnormal immune tests include anti-DNA or anti-Sm [Smith] antibodies, falsely positive blood test for syphilis, anticardiolipin antibodies, Lupus anticoagulant, or positive LE prep test.
Since the disease also alters metabolic functions other parameters hence
- Antithyroglobulin antibody
- Antithyroid microsomal antibody
- Complement components (C3 and C4)
- Coombs’ test – direct
- Rheumatoid factor
There is no cure for SLE, the aim is to control or alleviate symptoms and prevent flares, improve quality of life and provide optimum health care. This is achieved through diet protocols and medications. Medications are for Acute and Chronic management with respect to symptoms and severity of disease.
Mild afflictions [Arthritis, Pleurisy] are treated with Nonsteroidal anti-inflammatory medications (NSAIDs). Corticosteroid creams are used treat skin rashes.Many times an antimalaria drug (hydroxychloroquine) and low-dose corticosteroids are used for skin and arthritis symptoms.Protective clothing, sunglasses, and sunscreen are advised to be worn when in the sun.In advanced stages mere NSAIDs are ineffective and High-dose corticosteroids or medications to decrease the immune system response are administered. When Corticosteroids fail , Cytotoxic[anticancer drugs like "Methotraxate" which inhibit cell growth]drugs may be introduced which have serious, severe side effects.
SLE often presents severe or life-threatening symptoms;
- Blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism)
- Destruction of red blood cells (hemolytic anemia) or anemia of chronic disease
- Fluid around the heart (pericarditis), endocarditis, or inflammation of the heart (myocarditis)
- Fluid around the lungs (pleural effusions) and damage to lung tissue
- Pregnancy complications including miscarriage
- Severely low blood platelets (thrombocytopenia)
- Inflammation of the blood vessels
SLE causes damage to many different parts of the body which often require more aggressive treatment by doctor specialists. People with SLE often have to be alert about their Heart, Brain and Kidneys. Preventive heart care, Test to screen for bone density [Osteoporosis] is important. Some people with SLE have abnormal deposits in the kidney cells. This leads to a condition called Lupus Nephritis. Patients with this condition may eventually develop kidney failure and need dialysis or a kidney transplant. Women with SLE who become pregnant are often able to carry safely to term and deliver a healthy infant, as long as they do not have severe kidney or heart disease and the SLE is being treated appropriately. However, the presence of SLE antibodies may increase the risk of pregnancy loss.
Apart from these factors, Dozens of medications have been reported to trigger SLE. However, more than 90% of cases of Drug-induced Lupus occurs as a side effect of one of the following six drugs:
- Hydralazine (Apresoline) is used for high blood pressure;
- Quinidine (Quinidine Gluconate, Quinidine Sulfate) and procainamide (Pronestyl; Procan-SR; Procanbid) are used for abnormal heart rhythms;
- Phenytoin (Dilantin) is used for epilepsy;
- Isoniazid (Nydrazid, Laniazid) is used for tuberculosis;
- d-penicillamine (used for rheumatoid arthritis).
These drugs are known to stimulate the immune system and cause SLE. Fortunately, drug-induced SLE is infrequent (accounting for less than 5% of all people with SLE) and usually resolves when the medications are discontinued.
AYURVEDA INSIGHTS INTO SLE AND AUTO-IMMUNITY
Ayurveda describes a healthy state of each individual and an unhealthy state with different manifestations with respect to health. This unhealthy manifestations are grouped into certain syndromes which encompass all plausible symptoms a human body can exhibit. SLE and its manifestations can be easily traced through some logical conclusions. I would not venture into the technical conundrums as that would be beyond the scope of this article. SLE exhibits various manifestations in conjunction with overall immunity and organ affliction and hence treatment very well simplifies into following terms.
- Correcting the metabolic pathway so optimum nutrition is produced
- Creating a balance between bodily demand and supplies so the process of tissue repair is carried out flawlessly
- From above 2 ensuring a stable immunity reducing flare up of symptoms
- Giving stability to organs in form of tonics improving their resistance and promoting regeneration
The above 4 point protocol can be achieved by following a religious lifestyle in terms of diet and intake of herbal medicines. Long term use of Ayurveda medicine has an added benefit is that apart from curative action on afflicted organs they slowly fortify them preventing relapse as opposed to modern day chemicals which mostly aim at suppression.
Ayurveda is highly individualized and hence each patient must be approached with thought process unique to his/her environment and medicines and protocols devised likewise. There is no one medicine which may benefit all. Also while taking Ayurveda medicine one must keep in mind about ensuring results on the above 4 points mentioned rather than just pathological stability.I would like to point that each and every patient who suffers from SLE must only concentrate on having symptom free life with minimal medication and promoting overall quality.
Many a times a patient may be disease free from SLE for long periods but his pathological reports especially Antibodies [ANA] may not show much difference. Having high antibodies determines compromised immune symptom but in no way labels one as diseased. From my clinical experience of treating patients of Autoimmunity I am putting forth certain easy protocols which if followed would definitely help in a good quality of life. I have myself observed patients go into complete remission and in many cases the Antibodies [ANA] become negative. This still may indicate a very good control but must not be taken as a disease free state as immunity is subjective to environment around us and our response and if protocols are broken , it may severely relapse.
I would however sincerely request the readers , that if found effective, they must consult an Ayurveda physician to get treatments customized as per their clinical presentations.
One thing I always mention to SLE patients is to get tested for Heavy Metal toxicity especially Mercury and Lead. This I have found the most important culprit. If found in high levels, one must begin with chelation therapy either the modern medicine way or natural ways. Both require supervision. Chelation is a method where certain metal binding agents are given either orally or by IV which bind to the metals and throw them out. I personally use natural method for them as in SLE the primary toxicity is found of mercury. Once this detox is achieved in most cases the future treatment becomes very easy.
More than medicines, Lifestyle changes as advised by Ayurveda form a major core of this treatment. If one can follow these religiously, i am sure most of the patients will experience a sever drop in flare ups and would require less Allopathy medicine which would contribute to more organ strength and immunity
- Rise before sunrise [around 5 5.30]
- Go to bed by 10 pm -10.30pm maximum [This may be difficult but the work you do late night try to shift early morning]
- Do not sleep during day
- Have dinner before sunset [max 6pm]
- Drink warm water intermittently with food [max of 200ml]. Avoid drinking water before or after meals for at least an hour
- Stay away from Sunlight till a proper control is achieved or the corticosteroid dosage is reduced.
- Regarding bathing. I generally advise patients initially in my treatment to bathe with water medicated with Neem leaves [Azadhiracta indic a]. If Neem leaves are not available one can use Mint leaves. Do not have a head bath, just sponge your body. This can be done till swelling and flare ups are completely gone and do not come back till 45 days.
- Complete abstinence from Chillies, Yoghurt [Buttermilk without salt is fine], Pickles, Peas, Peanuts, Chana, Choley, Rajma, Mustard, Brinjals, Cauliflower
- Prepare food without salt. Add very minimal in water and sprinkle over the food. Try to restrict salt to once a day. This simple change will give you immense benefit
- Stay away from caffeine [Tea, Coffee, complete abstinence , not even Green tea]
- Completely avoid Sea food.
- Avoid following fruits, Banana, Orange, Sweet lime, Custard Apple, Jackfruit, watermelon
PROTOCOLS DURING MENSES
Women can utilize the menstrual cycle to recalibrate their hormonal system. As a rule I always advise women to go on a salt restricted diet comprising of Papaya and Rice water [see below] for 3 days. Avoid having bath and take the following simple herbal tea for 3 days in menses
- Dried Ginger 3gms
- Ajwoin 3gms
- Turmeric 2gms
- Jaggery 10gms
- Cow’s ghee 15gms
Boil this mixture in 200ml of water and reduce to 50ml. Consume it once a day for 3 days of cycle. This is dope regularly fortifies the immune system preventing flare ups.
The lifestyle and diet changes must be strictly followed. In addition I always advise my patients to watch out for change in seasons and seasonal cusps with respect to their geographical locations as this is the very time the immunity of the body is affected. During this time the patient must try and be off salt with minimal diet for a period of 3-4 days to ensure good immunity
I am listing few medicines which if coupled with above points will definitely show some positive results soon.
Rice Water : This is more of a home remedy. Boil unpolished rice [20-0gms] in an litre of water till rice is cooked. Slowly collect the water [without stirring or filtering] in another vessel, till very little water above rice remains. Drink this water at one go every night after sunset around 8pm. Regular use will cleanse most inflammatory process in the body. Remember this would only work if above protocols are followed
Medicated garlic. Soak entire garlic [simple not the special garlic] bulb in fresh curd for 24 hours. After this wash the garlic and peel each petal and store in a glass container. Each day before meals 10 mins fry 2 petals in Cow’s ghee [clarified butter from cow] and consume with warm water
Guduchi [Tinospora glabra stem 30gms], Sunth [Dried ginger 5gms] Boil this mixture in 300ml of water in an earthen vessel and reduce to 50ml. Filter and drink by adding 5ml of Castor oil 2times away empty stomach [as soon as you get up and at around 4pm]. When loose motions set in reduce true quantity of castor oil
Shyonak [Oroxylum indium, Tetu bark 30gms]. Boil in300ml of water, reduce to 50 ml and consume 2 times a day. I also recommend patients to use the left over bark to medicate bathing water. It helps reduce swellings and flare ups
Parijat [Nyctanthes arbor tristis bark, 20gms].Boil this mixture in 300ml of water in an earthen vessel and reduce to 50ml. Filter and drink by adding 5ml of Castor oil 2times away empty stomach [as soon as you get up and at around 4pm]. When loose motions set in reduce the quantity of castor oil. This is very useful in acute conditions to reduce joint pains and swellings
Gokshur [Pedalium murex fruits 7 gms], Kavach [Mucuna prurient seeds 5gms], Ashwagandha [Withania somnifera roots 5gms], Aragwadh [Pulp, Cassia fistula 5gms]. Boil this mixture in 300ml of water in an earthen vessel and reduce to 50ml. Filter and drink by adding 5ml of Castor oil 2times away empty stomach [as soon as you get up and at around 4pm]. When loose motions set in reduce true quantity of castor oil. This is a good remedy to reduce gene raised swellings, joint pains and fortify the immune system
The above medicines are only for patients who suffer from Joint pains , swellings and similar flare ups. In case of advanced complications involving brain, kidney I would recommend using the above medicine with advise from your physician. Please do not self medicate in such conditions. Many of the patients would be on corticosteroids or similar. If using the above remedies and diet protocol and one finds benefit, slowly taper the use of steroids with discretion.