Lupus disease: how Selena Gomez shone a light on a rare autoimmune disorder.

Selena Gomez

Although probably better known in America than the UK, the singer, actress and Netflix producer Selena Gomez has a huge global reach, selling over 7 million albums and 22 million singles worldwide to date. In 2017 she announced on Instagram that she had undergone a kidney transplant because of her pre-existing health problem of lupus. During this operation an artery ruptured and had to be reconstructed using one of her leg veins. Although her health is now steadily improving this highlights the impact that this often little-known health condition causes, with many sufferers having their lives shortened prematurely as a consequence.

Lupus is the shortened term used for the condition systemic lupus erythematosus (SLE), a chronic disease that causes inflammation in various parts of the body and which ranges in severity from mild to severe. It affects around 1 in 1,000 people in the UK and is six times more common in women than men, typically developing between the ages of 20 and 50 although it can occur at any age. More commonly found in people of Chinese, Asian or Afro-Caribbean origin it can sometimes run in families although any hereditary trigger is probably quite weak as it is not clear exactly why it should occur in someone. Possible causes suggested hormonal changes (which would explain the higher incidence in women), sunlight, some medicines and infections. What is well known however is that it is an autoimmune disorder, which essentially means that the body’s immune system starts to attack and destroy healthy cells in the body rather than protecting them. (Other examples where this occurs include rheumatoid arthritis, diabetes and thyroid problems).

Lupus symptoms vary hugely between sufferers and range from mild and intermittent to severe and life-threatening. The majority will report significant fatigue, weight loss and a mildly raised temperature but if these develop slowly or are only present occasionally they may be dismissed as minor symptoms or put down to other conditions before a diagnosis is finally made, in some cases many years later. Since it is a condition that mimics the symptoms of a great many other health conditions – many of them much more common – early diagnosis can often be frustratingly slow for people with lupus if it is not considered as a possibility from the outset.

Over half of lupus sufferers find their skin is very sensitive to sunlight and may develop a classical – and often diagnostic – rash over the cheeks and nose. This is known as the ‘butterfly rash’ because of its shape and often acts as a diagnostic trigger for doctors. Depression and anxiety are also common in lupus (Gomez suffered badly from this in 2016) along with joint pains that ‘flit’ from joint to joint and are worse first thing in the morning. If lupus progresses then other parts of the body apart from the skin and joints become inflamed and when severe there may be significant damage to the heart, kidneys, lungs or brain. The reason why many lupus sufferers experience flares and remissions of their disease is unknown.

If lupus is suspected the diagnosis is made using specialised antibody blood tests and although there is currently no cure, it can be controlled with medication (very mild cases may require no treatment at all) and most people with it lead active, normal lives. Treatment options include non-steroidal anti-inflammatory drugs, steroids, hydroxychloroquine and immunosuppressants that ‘damp down’ the immune system although these are usually only used in severe cases.

As a general rule I have found that for most people with lupus, if severe problems have not developed within a decade of diagnosis then it is unlikely they are going to in the future. Gomez was unfortunate in developing kidney problems at such a young age (she is now 27) but with modern immunosuppressive treatment she can now reasonably expect her career to continue on its highly successful course…

 

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