Lupus vs sarcoidosis
We are in an age where infections have been curtailed or eradicated to no longer being a scare. Nature has still found a way to keep the human population under check. Auto-immune disease is a new type of disease that has been identified in the recent decades and is growing steadily. Disorders in which the body’s defence system starts attacking its own cells due to a genetic mutation are termed as auto-immune disorders. Examples are Rheumatoid arthritis, sarcoidosis, systemic lupus erythematosus, Crohn’s disease, Ulcerative colitis, etc.
Systemic Lupus Erythematosus (SLE), commonly called as lupus, is one such auto-immune disease that has steadily increased in prevalence in the past decade or so. It affects multiple organs and tissues at the same time like heart, skin, joints, kidneys, nervous system, liver, lungs and blood vessels. Sarcoidosis is another auto-immune disease where inflammatory cells collect and form granulomas (nodules) in various tissues all over the body.
Lupus and sarcoidosis are known for their intermittent nature of exacerbations. There are periods when the patient is free of symptoms (remission) followed by severe flare-ups (exacerbations). There is no fixed duration of either the remission or exacerbation. Sarcoidosis is thought to be a reaction to an erstwhile infection which continues despite the infection being over. Genetics play an important role in both.
Symptoms of lupus can be seen in all the systems it affects. In the skin we can see disc-shaped rashes, butterfly rash on nose and cheeks, hairfall, ulcers in mouth/nose/ vagina. It produces joint pains of the small joints of hands like knuckles, wrists with swelling and redness. Deformities of joints are rare. It causes anemia and lowers platelet and white blood cell count of blood. It may cause inflammation of the linings of the heart like pericarditis, endocarditis or myocarditis. In the lungs it can cause inflammation of lungs’ covering called pleuritis, accumulation of fluid in lungs called effusion, haemorrhage into lungs, and diffuse inflammation of lung tissue. It can damage the kidneys leading to loss of protein and blood in urine. It can lead to kidney failure in the long term. It can also cause neuropsychiatric symptoms like seizures, psychosis, anxiety, confusion and nerve disorders.
Sarcoidosis produces symptoms wherever the nodules of the cells are formed. Liver, lungs, skin, eyes, brain, heart and blood may be affected. Lungs are affected most often having nodules and progressive breathlessness due to widespread inflammation within lung tissue. Enlargement of lymph nodes, inflammation of layers of eye called uveitis, damage to heart valves, anemia and spleen enlargement, pain in peripheral nerves, patchy hair fall and dry mouth are all manifestations from the other systems it affects. Joints and kidneys are rarely affected unlike lupus.
Diagnosis of lupus is by identifying antibodies called Anti-nuclear antibody (ANA) in the blood sample. There is a WHO criterion of 11 points including signs, symptoms and blood tests that is needed to confirm SLE. Sarcoidosis is identified often after excluding all other possible conditions. Chest x-ray, chest CT scan, tissue samples from symptomatic organs are commonly needed to arrive at a diagnosis.
There is no cure for lupus. Treatment aims at palliation and improving quality of life. Painkillers are given for joint pains. Dietary deficiencies are corrected by nutritional supplements. Steroids are often the choice of treatment to keep the exacerbations under check and prevent worsening of the disease. Symptomatic treatment is given for all other symptoms as well. Almost 30- 70% patients of sarcoidosis need no treatment. Symptoms when seen are handled using steroids and immunosuppressant like methrotrexate.
Take home pointers:
Lupus and sarcoidosis are both auto-immune diseases affecting multiple organs. Lupus has deposits of immune complexes while sarcoidosis has deposits of inflammatory cells that form nodules in organs.
Both are incurable and have periods of remission and flare-ups.
Both are treated with steroids.