Dr. Abhrajit Ray

MD (Cal), MRCP (UK), MRCP (London)
Consultant Physician & Rheumatologist
Radiant Medical Centre, Kolkata
Visiting Consultant Physician & Rheumatologist
Fortis, Bellevue, Woodlands Hospital, Kolkata


SLE is a chronic multisystem autoimmune disease with a waxing & waning course & tendency to cause hair loss, skin rash, cognitive dysfunction, heart disease, nephritis, osteoporosis & sometimes miscarriages. The broad spectrum of clinical features affects young ladies mostly between 16 to 55 years of age. Judicious use of sun screen creams, steroids, antimalarial agents, along with use of chemotherapy (cyclo, azathioprine) calcineurin inhibitors, IVIG, PE in selected cases by experts is necessary. Off label use anti CD 20 Rituximab & new use of anti-BLys Belimumab are sometimes useful.

What causes Lupus?

The immune system is the body's defense system. When healthy, it protects the body by making antibodies (blood proteins) that attack foreign germs and cancers. With lupus, the immune system misfires. Instead of producing protective antibodies, an autoimmune disease begins and makes "autoantibodies," which attack the patient's own tissues. Doctors sometimes refer to this as a "loss of self-tolerance."
As the attack goes on, other immune cells join the fight. This leads to inflammation and abnormal blood vessels (vasculitis). These antibodies then end up in cells in organs, where they damage those tissues. Why this inflammatory response begins is not clear. It most likely results from a mix of inherited tendencies and things in your environment. These include viruses, sunlight and drug allergies. People with lupus may also have an impaired process for clearing old and damaged cells from the body, which causes an abnormal immune response.
Most often, lupus starts in people in their 20s and 30s. The disease is more common in some ethnic groups, mainly blacks and Asians, and tends to be worse in these groups.

How is Lupus diagnosed?

Lupus can be hard to detect because it is a complex disease that has many symptoms, and they can come on slowly. As experts in diagnosing and treating autoimmune diseases such as lupus, rheumatologists can best determine whether a patient has lupus and advise them about treatment options.
People with lupus often have symptoms that are not specific to lupus. These include fever, fatigue, weight loss, blood clots and hair loss in spots or around the hairline. They may also have heartburn, stomach pain, and poor circulation to the fingers and toes. Pregnant women can have miscarriages.
list of symptoms and other measures that doctors can use as a guide to decide if a patient with symptoms has lupus. If your doctor finds that you have at least four of these problems, and finds no other reason for them, you may have lupus:
1) Rashes:
a) butterfly-shaped rash over the cheeks - referred to as malar rash
b) red rash with raised round or oval patches - known as discoid rash
c) rash on skin exposed to the sun
2) Mouth sores: sores in the mouth or nose lasting from a few days to more than a month
3) Arthritis: tenderness and swelling lasting for a few weeks in two or more joints
4) Lung or heart inflammation: swelling of the tissue lining the lungs (referred to as pleurisy or pleuritis) or the heart (pericarditis), which can cause chest pain when breathing deeply
5) Kidney problem: blood or protein in the urine, or tests that suggest poor kidney function
6) Neurologic problem: seizures, strokes or psychosis (a mental health problem)
7) Abnormal blood tests such as:
a) low blood cell counts: anemia, low white blood cells or low platelets
b) positive antinuclear antibodies (ANA) result: antibodies that can cause the body to begin attacking itself that are present in nearly all lupus patients
c) certain antibodies that show an immune system problem: anti-double-strand DNA (called anti-dsDNA), anti-Smith (referred to as anti-Sm) or antiphospholipid antibodies, or a false-positive blood test for syphilis (meaning you do not really have this infection