Systemic Lupus Erythematosus (SLE), commonly referred to as lupus, is a chronic autoimmune condition where the body’s immune system mistakenly attacks its own healthy tissues and organs. This can cause inflammation and damage in various parts of the body, including joints, skin, kidneys, blood cells, brain, heart, and lungs. The unpredictable nature of lupus means its symptoms can vary greatly and fluctuate over time, making it a complex disease to manage.
Lupus in the Korean Population
The prevalence and incidence of systemic lupus erythematosus in South Korea have shown distinct trends over the past decade. From 2005 to 2015, the annual prevalence of SLE in South Korea increased from approximately 21.25 per 100,000 people to 35.45 per 100,000 people. In contrast, the annual incidence of SLE saw a slight decrease during the same period, moving from 5.42 per 100,000 person-years to 3.6 per 100,000 person-years.
Lupus disproportionately affects women in Korea, with prevalence rates about 10 times higher and incidence rates about 6 times higher in women compared to men. The peak age for both prevalence and incidence of SLE in Korea has shifted, with the peak prevalence age moving from 30-39 years in 2005 to 30-49 years in 2015, and the peak incidence age shifting from 30-39 years to 20-49 years. Regional variations in SLE rates have also been observed, with Jeju province showing the highest prevalence and Gwangju province recording the highest incidence in 2015.
Genetic factors play a role in SLE predisposition within the Korean population, particularly concerning Human Leukocyte Antigen (HLA) genes located in the Major Histocompatibility Complex (MHC) region on chromosome 6. Specific HLA-DRB1 alleles are associated with increased lupus susceptibility in Koreans, including HLA-DRB115:01, 09:01, 08:03, and 07:01.
Conversely, some HLA-DRB1 alleles, such as 12:02 and 11:01, offer a protective effect against SLE. Multiple copies of risk alleles can have an additive effect, increasing the likelihood of lupus. These genetic predispositions influence overall risk and show associations with specific clinical manifestations and autoantibodies like anti-Sm. Beyond HLA, recent Korean research highlights the independent influence of Complement Component 4 (C4) gene number on lupus development.
Diagnosis and Management Approaches
Diagnosing lupus in Korea, as elsewhere, involves a comprehensive evaluation of a patient’s symptoms, physical examination findings, and laboratory test results. Blood tests are a cornerstone of diagnosis. Antinuclear antibodies (ANAs) are commonly tested, and a positive ANA test is a strong indicator, though not definitive. Further tests look for specific autoantibodies like anti-double-stranded DNA (anti-dsDNA) and anti-Sm antibodies, which are more specific to lupus.
Beyond antibody testing, blood work may include complete blood counts to check for anemia or low white blood cell and platelet counts, and erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) to assess inflammation levels. Urinalysis is performed to detect kidney involvement, a common complication of lupus, by looking for protein or blood in the urine. Imaging studies, such as X-rays or MRI scans, might be used to evaluate joint damage or inflammation in other organs, depending on the patient’s symptoms.
Lupus management in Korea involves a tailored approach, recognizing the disease’s diverse manifestations. Corticosteroids are prescribed to reduce inflammation and suppress the immune system, particularly during flare-ups. Immunosuppressants, such as azathioprine or mycophenolate mofetil, are used to dampen the immune response and reduce corticosteroid dosage, minimizing long-term side effects.
Biologic therapies, which target specific immune system components, are used for severe or refractory cases. Hydroxychloroquine, an antimalarial drug, is a common long-term treatment for skin and joint symptoms, reducing flare frequency. In the Korean healthcare system, patients receive care through specialized rheumatology clinics. Multidisciplinary teams, including nephrologists and dermatologists, collaborate to address varied organ involvement. Access to these medications and specialized care is integrated within the national health insurance system.
Navigating Lupus in Korean Society
Living with lupus in Korean society presents unique challenges stemming from both the chronic nature of the illness and prevailing cultural perceptions. The unpredictable flares and varying symptoms of lupus can significantly disrupt daily routines, affecting employment or social activities. This can lead to difficulties in the workplace, as employers may not fully understand the fluctuating health associated with autoimmune conditions.
Cultural perceptions of chronic illness in Korea can lead to misunderstandings or stigma. A societal expectation of outwardly appearing healthy can make it challenging for individuals with an invisible illness like lupus to receive empathy or support. The emphasis on collective well-being can also place pressure on individuals to manage health privately, hindering open discussions about their condition.
Family support systems play a significant role for individuals with lupus in Korea, providing emotional, practical, and sometimes financial assistance. However, the burden on family members can be substantial, highlighting the need for broader societal understanding and support. Patient advocacy groups and support networks are emerging in Korea, offering platforms for shared experiences, information exchange, and collective advocacy, alleviating feelings of isolation.
Some individuals managing lupus in Korea integrate complementary and alternative medicine (CAM) alongside conventional treatments. While conventional medicine remains the primary approach, some patients explore traditional Korean medicine or other CAM therapies. This approach is driven by a desire for holistic well-being or to manage symptoms not fully addressed by conventional treatments. It is pursued in addition to, not as a replacement for, prescribed medical care.