Global Health Asia-Pacific May 2022 May 2022 - Page 51

Nicole Chan at an event organised by Autoimmune Diseases Singapore
on the immune system .
Women seem to have more severe RA symptoms compared to men though “ it ’ s difficult to pinpoint exactly why this is ” the case , with several factors likely to influence the difference , said Dr Ma . “ Studies have found that this may be related to different perception of pain , worse quality of life outcomes and difference in the ability to continue with RA treatments .”
In lupus , antimalarial drugs play an important role in managing the condition , and some patients may have to take them for life , while immunosuppressants will also be required in severe cases . “ The antimalarial drug hydroxychloroquine may really be key if prescribed early because it helps prevent lupus from jumping into new organ systems and later organ damage ,” said Dr Petri .
One significant side effect associated with immunosuppressants , though , is the increased risk of infections because the drugs tend to switch off the immune system across the board , weaking its ability to fight off pathogens . This is why many patients with autoimmune diseases were given priority COVID-19 vaccinations as an at-risk group .
Appropriate exercise is also crucial to effectively manage both conditions .
“ It ’ s very important to keep active when you have rheumatoid arthritis because you need to keep your muscles conditioned , and movement can help relieve the main symptoms of RA , which are joint stiffness and pain , after resting for a long time ,” said Dr Ma . She also suggests doing gentle weight-bearing exercises as this can also help prevent osteoporosis , a disease that weakens the bones and a long-term risk associated with RA .
Similarly , “ several clinical trials have shown that women with lupus and chronic fatigue who enter in aerobic exercise programmes have immense benefits from it ,” said Dr Petri .
On top of that , managing psychological issues and reducing stress can make a difference as well . Psychological problems are very common in people with chronic pain , and talking to counsellors , family members , colleagues , friends , and other patients with autoimmune conditions can provide a lot of comfort , recommended Dr Ma .
Chan believes that keeping stress at bay in the workplace is particularly important as this is a common source of challenges for many people with autoimmune diseases , based on her personal experience and membership in the support group Autoimmune Diseases Singapore . To improve working conditions , she advocates for flexible working arrangements to help them get the job done without the need to be in the office all the time .
“ Since my diagnosis , I ’ ve been lucky to be in jobs where they value the work I can do rather than me being [ constantly ] in the office . I hope this can be the case for everyone ,” she said , noting that sometimes she needs to take time off either for check-ups or just to take a rest , but that doesn ’ t affect her productivity .
In terms of treatment outcomes , patients with RA who are treated early , within 12 weeks from symptom onset , can go into remission and have a chance to stop medications in the future . “ It doesn ’ t happen in everybody , but it is happening in more people than before ,” stressed Dr Ma . “ So it ’ s important that patients seek medical help early .”
The prognosis is bleaker for lupus as most patients with kidney disease , a common complication of the condition , don ’ t respond to treatment in the long term . “ Only 25 percent of people with lupus kidney disease have a complete response after one year of therapy . Lack of response means risk of end stage kidney disease requiring dialysis or a transplant ,” said Dr Petri . “ Lupus itself increases mortality ,” and it ’ s one of the leading causes of death in young women of colour .
How research could pave the way for cures Researchers are working to devise therapies that could end the plague of RA and lupus once and for all .
A promising line of RA research involves preventing the condition before it triggers symptoms . “ Treating patients early has been shown to be the best approach , however , now research is looking at treating before symptoms start to prevent the development of RA ,” said Dr Ma . The idea is to start treating individuals when they ’ re at risk of developing RA — those with a family history or with elevated autoantibodies — to see whether this will delay or stop the development of the disease in the future . “ It ’ s still early days , but there are some promising studies ” that will provide some answers soon .
Research on lupus is taking a somewhat different approach . Scientists are trying to untangle its multiple mechanisms of action , especially with regard to kidney disease , to identify key targets for new medications in a similar way that cancer research has led to the development of drugs that disrupt specific processes of malignant cell growth .
“ I think we ’ re going to see the treatment of lupus accelerate and become personalised ” thanks to new targeted therapies that are tailored to fix the specific disease pathways in each individual patient , explained Dr Petri .
She said that one promising approach now undergoing testing involves increasing the number of functional immune cells to strengthen the immune system , thus allowing it to control autoimmune diseases and effectively providing a definitive cure . n
The prognosis is bleaker for lupus as most patients with kidney disease , a common complication of the condition , don ’ t respond to treatment in the long term .
GlobalHealthAsiaPacific . com MAY 2022
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