During Black History Month each year some focus is always placed on health disparities caused by socioeconomic factors. Black people get diagnosed later, or have poorer follow up, or do not have equitable access to gold standard medications or treatment and therefore have poorer outcomes. This is true for diseases like hypertension, diabetes and many others. However, some diseases affect black people preferentially due to genetic factors and those are worth highlighting not only for Black History month but as much as we can. One of the most devious, is Systemic Lupus Erythematosus, which is an autoimmune disease with a high prevalence in black women. Working as a doctor in the Caribbean, I’ve seen the devastating effects of Lupus on black women. The medication is both expensive and harsh on the body and so one can imagine that this, combined with health disparities due to socioeconomic inequity and a disease which attacks black women preferentially, makes this a really important disease to talk about.
Autoimmune diseases are diseases in which the body uses its defenses to attack its own healthy cells and organs. Your immune system should protect you from foreign invaders that attack your cells, instead that same immune system is attacking your healthy cells; devastating to say the least. It is as bad as it sounds. Besides lupus, other fairly well known autoimmune diseases include Coeliac disease, Type 1 diabetes, Graves disease (hyperthyroidism) and psoriasis. They all range in severity amongst each other but also for some of them, the severity changes within the course of disease. Sometimes the diseases are fairly inactive while at other times they flare badly. Lupus is a classic flare and remit disease, and even flares can be of varying intensities, ranging from skin effects like the characteristic red butterfly rash on the face, to some of the most devastating flares like Lupus Nephritis (autoimmune attack on the kidneys) and neurological flares like optic neuritis (an autoimmune attack on the nerve we use to see-the optic nerve) or the psychiatric manifestations of Lupus referred to lupus cerebritis.
Complications of flares are both psychological and physical. Psychological effects occur from the constant fear of a flare, frustration from trying to avoid triggers like stress and infection but still flaring anyway, low perception of self image after repeated skin flares, low perception of self image after the effects of weight gain, stretch marks and thinning skin from the medication (catabolic steroids) necessary to treat lupus, the knowledge that many patients with lupus are sub-fertile due to disease processes or medication, and of course the knowledge that mortality at a young age is still a reality especially in those with inequitable access to care. Lupus affects every system in the body and so the physical effects are far ranging. They include end stage kidney disease, painful swollen joints, that may in severe cases deform, swollen lymph nodes, seizures, inflammation of the heart, inflammation of the lungs and more.
This disease is devastating and deadly. Women are 9 times more likely to have lupus than men and according to statistics from the USA, black women are almost 3 times more likely to have lupus than white woman. It cannot be overstated how important it is for black women to be aware of this disease and its relationship with the female black population.