Explainer: what is lupus and how is stress implicated?



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Lupus is the body’s immune system attacking itself.
from http://www.shutterstock.com

Eric Morand, Monash Health

Thanks to Selena Gomez and Dr House, most of us have heard of lupus. But most of us don’t know what it is, and until recently, none of us were sure whether stress could be a risk factor.

The simplest way to understand lupus is “your immune system gone wrong”.

We have evolved powerful immune systems to detect, attack, and destroy invading microbes. But if the immune system makes an error in the “detect” stage – incorrectly recognising some part of us as foreign – it will attack it with all of the tools at its disposal.

This self-directed, or “auto”-immunity, is the basis of countless diseases, from juvenile diabetes to multiple sclerosis. But unlike those examples, in which the immune system attacks just one tissue, in lupus all tissues of the body can be targeted.




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This can mean anything from a rash and arthritis to the immune system disrupting the function of the brain, heart, and kidney. Some sufferers may have minor symptoms such as tiredness and joint pain that resolves within a few months, but for some the disease can last for years and require transplantation of damaged organs.

These symptoms can arrive in any order at any time, and cause a severe loss of quality of life and reduction in life expectancy. As lupus mostly affects young adult women, the impact of this is great.

Why does this happen?

We are much closer now to being able to answer this question, thanks in part to being able to analyse gene expression in people with the disease.

We know from genetic studies that at least some risk of lupus is inherited from our parents, but we also know that inheritance explains only a fraction of the risk of getting lupus. So other factors must contribute.

It now appears that a large subset of lupus patients’ disease is caused by mechanisms the immune system normally uses to combat viruses. The immune system produces virus-fighting hormones (called “cytokines”) such as interferon – which activates the production of antibodies and destructive inflammation intended to kill the infection. When this happens by error, and is directed at the self, tissue inflammation and damage occur.

Current treatments are limited to non-specific immune suppressant drugs “borrowed” from other diseases such as arthritis, and drugs used to stop an organ recipient’s body rejecting the donor organ. Although life-saving in many cases, these drugs have major side effects and don’t control all patients’ disease.




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How is stress related to lupus?

As a rheumatologist I treat patients in hospital with musculoskeletal diseases and autoimmune conditions. A patient of mine suffering from lupus had, some time prior to diagnosis, been the victim of an assault, which caused post-traumatic stress disorder (PTSD).

This case posed to me, and more importantly to the patient, the question of whether stress could have led to the development of lupus. Until recently this question has been effectively unanswerable.

A new study looked at data reporting on the association of trauma and PTSD with the incidence of lupus. It found that PTSD was associated with a nearly threefold increase in risk of subsequently developing lupus.

A study found a link between PTSD and auto-immune conditions in service personnel.
from http://www.shutterstock.com

A past history of trauma, regardless of carrying a PTSD diagnosis, was associated with a similar threefold increase in the risk of lupus.

These findings confirm a previous study of ex-service personnel, in which PTSD was both disturbingly prevalent and also a powerful risk factor for the development of autoimmune diseases, including lupus.




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The association of stress and the immune system dates back to the 1930s, when pioneering endocrinologist Hans Selye found that there are distinct changes in the body in response to a threat. The term “stress” was also attributed to Selye, albeit coined much later.

Crucially, Selye also observed that stress results in disturbances in steroid hormone production. As we now know, the body’s naturally occurring steroids act through the same pathway as steroid drugs used to treat lupus. This provides a possible mechanism for the connection between stress and the control of immunity.

Intriguingly, some organ manifestations of lupus, such as severe skin or blood disease, are notoriously resistant to steroids, and recent laboratory studies suggest interferon activation in lupus may be responsible for this steroid resistance. Thus, stress, changes in steroid production, and failure to suppress interferons may represent a chain of events influencing the development of lupus.

The ConversationSo this new study means we’re a little less unsure about the causes of auto-immune diseases. And while sufferers can’t change past life events, knowing the causes brings us closer to understanding, and to better treatments.

Eric Morand, Head, School of Clincial Sciences at Monash Health, Monash Health

This article was originally published on The Conversation. Read the original article.

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Legal Status Foreseen for Christianity in Buddhist Bhutan


Country’s religious regulatory authority expected to consider recognition before year’s end.

NEW DELHI, November 4 (CDN) — For the first time in Bhutan’s history, the Buddhist nation’s government seems ready to grant much-awaited official recognition and accompanying rights to a miniscule Christian population that has remained largely underground.

The authority that regulates religious organizations will discuss in its next meeting – to be held by the end of December – how a Christian organization can be registered to represent its community, agency secretary Dorji Tshering told Compass by phone.

Thus far only Buddhist and Hindu organizations have been registered by the authority, locally known as Chhoedey Lhentshog. As a result, only these two communities have the right to openly practice their religion and build places of worship.

Asked if Christians were likely to get the same rights soon, Tshering replied, “Absolutely” – an apparent paradigm shift in policy given that Bhutan’s National Assembly had banned open practice of non-Buddhist and non-Hindu religions by passing resolutions in 1969 and in 1979.

“The constitution of Bhutan says that Buddhism is the country’s spiritual heritage, but it also says that his majesty [the king] is the protector of all religions,” he added, explaining the basis on which the nascent democracy is willing to accept Christianity as one of the faiths of its citizens.

The former king of Bhutan, Jigme Singye Wangchuck, envisioned democracy in the country in 2006 – after the rule of an absolute monarchy for over a century. The first elections were held in 2008, and since then the government has gradually given rights that accompany democracy to its people.

The government’s move to legalize Christianity seems to have the consent of the present king, Jigme Khesar Namgyel Wangchuck, who is respected by almost all people and communities in the country. In his early thirties, the king studied in universities in the United States and the United Kingdom. Prime Minister Lyonchen Jigmey Thinley is also believed to have agreed in principle to recognition of other faiths.

According to source who requested anonymity, the government is likely to register only one Christian organization and would expect it to represent all Christians in Bhutan – which would call for Christian unity in the country.

All Hindus, who constitute around 22 percent of Bhutan’s less than 700,000 people, are also represented by one legal entity, the Hindu Dharma Samudaya (Hindu Religion Community) of Bhutan, which was registered with the Chhoedey Lhentshog authority along with Buddhist organizations a year ago.

Tshering said the planned discussion at the December meeting is meant to look at technicalities in the Religious Organizations Act of 2007, which provides for registration and regulation of religious groups with intent to protect and promote the country’s spiritual heritage. The government began to enforce the Act only in November 2009, a year after the advent of democracy.

Asked what some of the government’s concerns are over allowing Christianity in the country, Tshering said “conversion must not be forced, because it causes social tensions which Bhutan cannot afford to have. However, the constitution says that no one should be forced to believe in a religion, and that aspect will be taken care of. We will ensure that no one is forced to convert.”

The government’s willingness to recognize Christians is partly aimed at bringing the community under religious regulation, said the anonymous source. This is why it is evoking mixed response among the country’s Christians, who number around 6,000 according to rough estimates.

Last month, a court in south Bhutan sentenced a Christian man to three years of prison for screening films on Christianity – which was criticized by Christian organizations around the world. (See http://www.compassdirect.org, “Christian in Bhutan Imprisoned for Showing Film on Christ,” Oct. 18.)

The government is in the process of introducing a clause banning conversions by force or allurement in the country’s penal code.

Though never colonized, landlocked Bhutan has historically seen its sovereignty as fragile due to its small size and location between two Asian giants, India and China. It has sought to protect its sovereignty by preserving its distinct cultural identity based on Buddhism and by not allowing social tensions or unrest.

In the 1980s, when the king sought to strengthen the nation’s cultural unity, ethnic Nepalese citizens, who are mainly Hindu and from south Bhutan, rebelled against it. But a military crackdown forced over 100,000 of them – some of them secret Christians – to either flee to or voluntarily leave the country for neighboring Nepal.

Tshering said that while some individual Christians had approached the authority with queries, no organization had formally filed papers for registration.

After the December meeting, if members of the regulatory authority feel that Chhoedey Lhentshog’s mandate does not include registering a Christian organization, Christians will then be registered by another authority, the source said.

After official recognition, Christians would require permission from local authorities to hold public meetings. Receiving foreign aid or inviting foreign speakers would be subject to special permission from the home ministry, added the source.

Bhutan’s first contact with Christians came in the 17th century when Guru Rimpoche, a Buddhist leader and the unifier of Bhutan as a nation state, hosted the first two foreigners, who were Jesuits. Much later, Catholics were invited to provide education in Bhutan; the Jesuits came to Bhutan in 1963 and the Salesians in 1982 to run schools. The Salesians, however, were expelled in 1982 on accusations of proselytizing, and the Jesuits left the country in 1988.

“As Bhutanese capacities (scholarly, administrative and otherwise) increased, the need for active Jesuit involvement in the educational system declined, ending in 1988, when the umbrella agreement between the Jesuit order and the kingdom expired and the administration of all remaining Jesuit institutions was turned over to the government,” writes David M. Malone, Canada’s high commissioner to India and ambassador to Bhutan, in the March 2008 edition of Literary Review of Canada.

After a Christian organization is registered, Christian institutions may also be allowed once again in the country, given the government’s stress on educating young Bhutanese.

A local Christian requesting anonymity said the community respects Bhutan’s political and religious leaders, especially the king and the prime minister, will help preserve the country’s unique culture and seeks to contribute to the building of the nation.

Report from Compass Direct News