August 19, 2016


Dr. Aung Soe (a) Aung Kyaw Moe
Retired State Medical Superintendent

Not long ago, a news item appeared in esteemed GNLM on 10 October 2015 regarding the health of pop singer and actress Selena Gomez, which alarmed the young star’s fans in Myanmar as well as abroad. Gomez revealed in an interview that she was diagnosed with the auto-immune disease, lupus, which led to her cancelling the end of her tour in 2013, but that the disease is now in remission. At that time the popular actress cum pop singer has just passed her teens, as such she is 23 now.
Although the music loving fans all over the globe, including our own country are anxious about this shocking and unhappy event, very few know what the lupus is, which their loved vocalist is suffering. Allow me to high-light some salient facts of lupus.
Lupus is an autoimmune disease, that is, a disease in which the defence mechanism of the person attacks its own body cells. In other words, lupus is a chronic inflammatory disease of uncertain etiology (cause), characterized by B cell hyperactivity, activatation of complement and T-cell defects. B cells, complements and T cells are defence mechanism factors in the body. In fact, these factors are meant for destroying the harmful foreign disease elements which enter the body. But, in stead, in lupus, they fight and try to destroy its own native body cells and tissues, in abnormal manners.
Including the attractive pop singer Selena, 90 percent of lupus patients are female. Blacks have the greatest incidence. Not sure, Gomez is Negro-mixed, as her complexion on the screen is slightly tan in audience’s sight. Peak onset of lupus occurs in teens and middle aged individuals and Selena is just over 20 now. Increased incidence is found in close relatives and flares up often during pregnancy.
As Selena Gomez has already under went thorough diagnostic procedures and lab tests, lupus is to be differentiated with such ailments as rheumatoid arthritis (painful swollen, deformed joints disease), lymphoma. (malignant and benign tumours of lymphoid tissues), vasculitis (inflammation of blood vessels, such as arteries, veins, capillaries, lymph vessels), HIV, drug-induced Systemic Lupus Erythematosus (SLE) due to such drugs as procainamide, isoniazid, hydralazine, poly dermatomyositis (multiple inflammation of skin and muscle tissues), Sjogren’s syndrome etc.
In an interview with Billboard magazine, popular star famous for singing educative and charity songs, as well as pleasant lyrics of love and lust, revealed she cancelled concerts in Russia and Australia, as she could have had a stroke!
Signs and symptoms of such a drastic ailment vocalist suffers are numerous, as we were tought during our student days in early 1960 s in faculty of Medicine, Rangoon University, (so called then) and later in Continuing Medical Education and refresher courses throughout the career and even up to date.
–     Malar (‘butterfly”) or discoid (red. raised, scaly) rash around nose and cheeks
–     Fatigue
–     Myalgias and arthralgias (muscle and joint pain)
–     Arthritis — symmetrical and migratory, especially in fingers, hands, wrists, and knees
–     Photosensitivity (sensitivity to light)
–     Seizures (Selena could develop on the stage)
–     Cognitive dysfunction, decision making, perceptions
–    Fever
–     Alopecia, (slow movements)
–     Lymphadenopathy. Commonly seen lymph nodes in neck, armpits, groins otherwise invisible and unpalpable
–     Edema secondary to renal disease (puffiness of face, swollen feet, abdomen etc.
Signs and symptoms of lupus are so troublesome that they give rise to instability of mind, ‘disturbed mood, resulting in anger. Talented singer Selena once said she needed to spend some time on herself. The move on the stage, followed by a stint, at an Arizona rehabilitation facility, generated tabloid, rumours of struggles with pills, alcohol, or even difficulties over her breakup with pop star Juston Bieber, which Gomez told Billboard angered her. “I wanted so badly to say, ‘You guys have no idea. I’m in chemotherapy” she told the magazine in its issue which was out in her angry days,
Generally, following treatment schedule is recommended for lupus, it is described in one of the textbooks:-
–     Avoid sun exposure
NSAIDs for arthralgias, (joint pains) myalgias, (muscle pains) and fever
–     Hydroxychloroquine for skin rashes
–     Severe disease with complications
–     Glucocorticoids
–     Cytotoxic drugs; Cyclophosphamide, azathioprine, mycophenolate, methotrexate
–     Warfarin for anticoagulation in cases of antiphospholipid antibody syndrome – WIG for acute thrombocytopenia, hemolytic anemia
–     Screen for and treat osteoporosis (fragility of bones)
As such, prognosis of lupus depends upon severity of disease and efficacy of management. Lupus has a choric course with exacerbations and remissions. Selena was interviwed during remission.
–     Complication include tendon disease and ruptures, avascular necrosis of hip and other joints (due to chronic steroid use). Thrombosis, vasculitis, glomerulonephritis pericarditis, pleural effusions, pncumonitis.
–     >90% are alive 2 years after diagnosis. 70% are alive 20 years after diagnosis.
–     Indicators of poor prognosis. I-ITN, nephritic syndrome, creatinine > 1.4, anemia.
–     Most common causes of death in the initial decade after diagnosis are infections and renal failure; thromboembolic events are the most common causes of death theteafter. Lucky enough, Selena Gomez’s condition is not so bad, it is learnt. No doubt, admirers all over the world are praying for recovery, good health and long life of talented artist they love.


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