SLE Flares: Triggers and Prevention

1.Introduction:

Mrs. Rajitha’s battle with Systemic Lupus Erythematosus (SLE) is a testament to perseverance and the power of exploring alternative healing methods. From enduring relentless joint pain and ineffective treatments to embracing a naturopathic approach, her journey highlights the challenges of chronic illness, and the hope found in holistic care.

2.Patient Information:

In 2023, 28-year-old Mrs. Rajitha first noticed joint pain in her fingers. It spread to her shoulders, neck, and knees, with a heat sensation in her ears and nose. By July 2024, she sought help at Medicover Hospital in Hyderabad, where an ANA test confirmed her diagnosis of Systemic Lupus Erythematosus. However, medications didn’t alleviate her symptoms. Rajitha sought another opinion at Lotus Hospital in August 2024, but the treatment plan remained unchanged. Soon after, her condition worsened, leading to severe skin rashes and breathing difficulties, which required ICU care at Viva Hospital, Telangana. While her rashes and breathing issues improved, her joint pain persisted. At a low point, a neighbor recommended SLNS Nature Cure Hospital, known for its naturopathic treatments. Intrigued by the holistic approach, Rajitha began a new journey focusing on restoring her body’s natural balance through dietary changes, stress management, and holistic care.

3.Medication History:

S.No	Present medication	Medication (After treatment)	Mechanism of the drug
1	Folic acid 5 mg (0-0-1)	Tapered	Supplement
2	Hydroxychloroquine Sulphate 200 mg (1-0-1)	1-0-1	Inhibits protein synthesis by blocking DNA and RNA polymerase in susceptible organisms
3	Methotrexate 7.5 mg   1-0-1 (weekly)	1-0-1 (weekly)	Promotes adenosine release and inhibits inflammation pathways, reducing pain and disease progression
4	Methylprednisolone 8 mg (1-0-0)	Tapered	Binds to glucocorticoid receptors to promote anti-inflammatory signals and inhibit proinflammatory signals
5	Levocetirizine 5 mg, Montelukast 10 mg (0-0-1)	Tapered	Acts as an inverse agonist to reduce histamine H1 receptor activity and inflammation

The treatment plan included the tapering of folic acid as a supplement and methylprednisolone after achieving its anti-inflammatory effects. Hydroxychloroquine sulphate was continued at a dosage of 1-0-1 to inhibit protein synthesis, while methotrexate was maintained weekly (1-0-1) to manage pain and inflammation. Additionally, levocetirizine and montelukast were gradually reduced to decrease histamine H1 receptor activity.

4. Naturopathic and Lifestyle Intervention:

Anti-inflammatory Diet: Emphasized whole, unprocessed foods rich in antioxidants, like fruits, vegetables, omega-3 fatty acids (found in flaxseeds, walnuts, and fish), and turmeric for its anti-inflammatory properties.

Hydration and Herbal Support: Stayed hydrated and include herbal teas like ginger tea to reduce inflammation. 

Stress Management: Practiced yoga, meditation, and breathing exercises to lower stress, a known trigger for SLE flare-ups. Mindfulness practices improved emotional resilience and reduced inflammation.

Adequate Rest and Sleep: Prioritized consistent sleep schedules and rest periods to allow the body to heal and manage fatigue associated with SLE.

Detox and Gut Health: Detoxification through vegetable juices or fasting under supervision. Probiotics and prebiotic-rich foods support gut health, which is critical in autoimmune conditions.

5. Results and Follow-Up:

S.No	Parameter	Before Treatment	After Treatment
1	Platelet Count	480	273
2	WBC	10.15	2.5
3	RBC	5.35	4.42
4	Hemoglobin	15.5	12.7
5	VLDL	50.27	22.74
6	Cystatin C	1.24	1.17
7	ANA	207.49	185.03
8	Copper	155.37	135.25
9	DHEA	44.24	177.14
10	DHEA S	17.66	67.4
11	Testosterone	11.76	37.13
12	Lipoprotein A	16.3	12
13	Cortisol	2.56	8.52
14	Deoxycortisol	21.15	24.85
15	Corticosterone	68.28	71

Platelet Count decreased from 480 to 273, indicates reduced inflammation and internal clotting. WBC Levels dropped from 10.15 to 2.5, signifying better immune regulation and lower inflammation. RBC Levels lowered from 5.35 to 4.42, reflecting enhanced hydration, oxygen transport and overall blood quality. Hemoglobin decreased from 15.5 to 12.7, indicating improved oxygen carrying capacity to tissues, metabolic function and energy levels. VLDL Levels reduced from 50.27 to 22.74, signifying a healthier lipid profile and decreased cardiovascular risks. Cystatin C Levels showed reductions post-treatment, indicating improved kidney function. ANA Levels decreased from 207.49 to 185.03, suggesting reduced autoimmune activity. Copper Levels declined from 155.37 to 135.25, indicating better mineral balance for essential bodily functions and improved liver. DHEA Levels increased significantly from 44.24 to 177.14, suggesting hormonal balance and improved vitality. Testosterone Levels: Rose from 11.76 to 37.13, contributing to enhanced energy and overall wellness. Lipoprotein A Levels: Dropped from 16.3 to 12, further indicating improved cardiovascular health. Cortisol: Increased from 2.56 to 8.52, indicating a potential rise in stress response or adrenal activity. Deoxycortisol: Rose from 21.15 to 24.85, suggesting enhanced adrenal hormone production and possible implications for stress management. Corticosterone: Increased from 68.28 to 71, indicating a rise in anti-inflammatory effects and potential adaptation to stress

6. Discussion:

Mrs. Rajitha’s case highlights the challenges of managing SLE with conventional treatments alone and the value of exploring holistic care. Naturopathic interventions, including dietary changes, stress management, and lifestyle adjustments, addressed underlying triggers and offered relief where medications fell short. Her journey emphasizes the importance of integrative care for long-term improvement in chronic autoimmune conditions.

7. Conclusion:

In conclusion, Mrs. Rajitha’s case exemplifies the importance of early diagnosis and treatment in managing Systemic Lupus Erythematosus. The gradual onset of symptoms, initially marked by joint pain and progressing to more complex signs, was confirmed with a positive ANA test in July 2024. This timely diagnosis has paved the way for effective management, with significant improvements noted across various parameters. The lab results reflect positive progress, including decreases in VLDL, cystatin C, and copper levels, which suggest improvements in lipid metabolism and kidney function. Additionally, the reduction in platelet count and white blood cells points to a favorable response to treatment, helping reduce inflammation and immune activity.

Symptomatically, Mrs. Rajitha has experienced remarkable improvement. Many symptoms, such as headaches, ear infections, chronic cough, sore throat, swollen lips, sweating, restlessness, and tiredness, have significantly reduced and the issues of dry skin and hair loss prognosis remains positive which reflecting the treatment’s effectiveness. Even excess weight and arthritis have shown improvement, contributing to her overall well-being. Overall, the treatment has led to a positive trend in Mrs. Rajitha’s health, and continued monitoring will ensure sustained progress and long-term management of her condition.