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Systemic Lupus Erythematosus: Disease that can affect almost any organ

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Dr. Aruna Caldera shares expert insights

The immune system is designed to protect the body from harmful invaders such as viruses and bacteria and to remove abnormal or damaged cells. However, in some individuals the immune system malfunctions and mistakenly attacks the body’s own tissues. Diseases caused by this type of immune response are known as autoimmune diseases.

Systemic Lupus Erythematosus (SLE) is one such autoimmune disease and can be potentially devastating if not diagnosed and treated early. SLE most commonly affects women between the ages of 15 and 45, and nearly 90% of patients are female.

What is Systemic Lupus Erythematosus?

SLE is a multi-system autoimmune disease, meaning it can affect multiple organs in the body simultaneously. The main underlying process in lupus is inflammation caused by the immune system attacking the body’s own tissues.

The exact biological mechanisms behind SLE are complex, similar to many other rheumatological diseases. Because the disease can affect multiple organs and vary greatly from person to person, managing SLE requires extensive knowledge of its behaviour. Many patients are cared for by specialists such as rheumatologists, nephrologists, and dermatologists.

An important feature of SLE is its tendency to flare when treatment is stopped or altered without medical advice, making long-term adherence to therapy essential.

Systemic Lupus Erythematosus (SLE) commonly known as Lupus, s a complex auto immune disease that affects million of people worldwide, particularly women. Characterised by the immune disease that affects millions of people worldwide, particularly women. Characterised by the immune system mistakenly attacking the body’s own tissue, lupus can impact the skin, joints, kidneys and other vital organs. To better understand this often misunderstood condition, we spoke with Dr. Aruna Caldera who shares insights into the causes, symptoms, treatment and the importance of awareness surrounding systemic lupus erythematosus.

(Q) What Causes SLE?

(A) The exact cause of SLE remains unknown, but research suggests that it develops due to a combination of factors such as genetic susceptibility, hormonal influences, environmental triggers, immune system abnormalities, epigenetic changes. More than 100 genetic variants associated with susceptibility to lupus have been identified.

In people with SLE, immune cells such as B cells and T cells mistakenly recognize the body’s own tissues as foreign. This leads to the production of autoantibodies; antibodies directed against normal components of the body.

Interestingly, these antibodies can sometimes be present in the blood years before symptoms appear. Over time, the immune reaction may lead to inflammation and damage in various organs.

Common Symptoms to Watch For

Because lupus can affect many organs, symptoms may vary widely. Some symptoms are also non-specific, which can make diagnosis difficult. Common symptoms of SLE include severe fatigue, joint pain and swelling, low-grade fever (sometimes may cause high fever), skin rashes, hair loss, mouth ulcers. Some skin rashes may worsen after sun exposure, a feature known as photosensitivity.

(Q) Why Is Lupus Sometimes Difficult to Diagnose?

(A) Diagnosing SLE can be challenging because symptoms often appear gradually and may not occur at the same time. Additionally, many symptoms of lupus overlap with those of other medical conditions. As a result, doctors often need to consider a combination of clinical symptoms, blood tests, and imaging studies before confirming the diagnosis.

Skin Manifestations of Lupus

Skin involvement is common in lupus. One well-known sign is the butterfly rash (malar rash), which appears across the cheeks and the bridge of the nose while typically sparing the folds beside the nose (nasolabial folds). This rash often becomes more pronounced after sun exposure.

Hair loss (alopecia) is also frequently seen. In many patients this is non-scarring, meaning the hair follicles remain intact and hair can regrow. However, some conditions such as scarring alopecia can permanently damage hair follicles. Another related condition is discoid lupus erythematosus (DLE), which mainly affects the skin and can lead to scarring lesions and permanent hair loss. A small proportion of patients with discoid lupus may later develop systemic lupus.

Mouth ulcers are another common feature. Unlike the typical painful ulcers many people experience, lupus-related ulcers are often painless and may occur on the palate.

Other skin findings may include raynaud’s phenomenon (bluish-red discoloration of the fingers), skin vasculitis, other types of rashes.

Kidney Involvement: Lupus Nephritis

One of the most serious complications of SLE is lupus nephritis, which affects the kidneys. If untreated, lupus nephritis can lead to significant kidney damage.

The condition is classified into six classes based on kidney biopsy findings. Mild forms (class I and II) may require only standard lupus treatment, while more severe forms require intensive immunosuppressive therapy. Advanced disease may eventually require dialysis or kidney transplantation.

All lupus patients should undergo routine screening for kidney involvement, typically starting with a urine test to detect protein leakage. If abnormal findings are present, a kidney biopsy may be performed to determine the exact type and severity of kidney disease. Interestingly, blood creatinine levels may still appear normal in the early stages of kidney involvement, which is why urine testing is essential.

Other Organs That May Be Affected

Brain and Nervous System

Well known sign is butterfly rash which appears across the face

When lupus affects the brain or nervous system, it is referred to as neuropsychiatric lupus. Symptoms may include headaches, seizures, stroke, nerve palsies, psychosis. Diagnosis can be challenging and often requires multiple investigations to rule out other causes.

Lymph Nodes

Enlarged lymph nodes, particularly in the neck, may occur in lupus. However, doctors must rule out other conditions such as Kikuchi disease, lymphoma, Tuberculosis because the treatments for these conditions are very different.

Joints

Joint inflammation (arthritis) is common in lupus. Unlike rheumatoid arthritis, lupus arthritis usually does not cause severe joint deformities. In rare cases, a condition known as Jaccoud’s arthropathy may develop.

Heart

Lupus can affect different parts of the heart, including, the heart lining, the heart muscles, the heart valves. Inflammation may lead to fluid accumulation around the heart, rhythm abnormalities, or other complications.

Lungs

The lungs may also be affected due to inflammation of lung tissues. Severe lung complications are less common today due to improved treatment options.

Lupus and Blood Clots

Some lupus patients develop a condition called antiphospholipid syndrome. This condition increases the risk of abnormal blood clot formation. Possible complications include deep vein thrombosis, pulmonary embolism and pregnancy complications Because of this risk, pregnant women with lupus are often screened for antiphospholipid antibodies and treated with medications that reduce the risk of clot formation when necessary.

Lupus and Pregnancy

General Manager – Dhinal Perera

Pregnancy in women with lupus is considered high risk for both the mother and the baby. Potential complications include premature delivery, low birth weight, blood clotting disorders, certain fetal heart conditions However, with careful monitoring and specialist care, many women with lupus can have successful pregnancies.

Diagnostic Tests for Lupus

Doctors use a combination of laboratory tests and clinical findings to diagnose lupus.

Common investigations include:

Full blood count (FBC) – may show low white cells, platelets, or hemoglobin

Erythrocyte sedimentation rate (ESR) – often elevated

Urine PCR and other urine analysis to detect kidney involvement

ANA (antinuclear antibodies) test – commonly positive in lupus

Anti-double stranded DNA (dsDNA) antibodies and Complement levels (C3 and C4) to measure the disease activity.

Many other organ specific tests may be warranted

No single test can confirm lupus with 100% certainty, so diagnosis usually depends on a combination of clinical features and laboratory results.

Treatment Options

Treatment depends on the severity of the disease and the organs involved. Almost all lupus patients receive hydroxychloroquine, which is considered a cornerstone of therapy. Other medications may include Prednisolone (steroids), Azathioprine, Mycophenolate mofetil, Methotrexate, Cyclophosphamide, Rituximab, Belimumab and other biologic therapies

These medications work by controlling the abnormal immune response and reducing inflammation.

Long-Term Outlook

Although SLE remains a chronic lifelong condition without a complete cure, modern treatment has dramatically improved outcomes.

Today, more than 90% of patients survive beyond 10 years, and many individuals can live near-normal lifespans with appropriate medical care.

Importance of Early Diagnosis

Early recognition of lupus is crucial. A useful clinical principle often emphasized in medical training is, “any unexplained multi-system inflammatory illness should raise suspicion for lupus”.

Early diagnosis and proper treatment can prevent serious organ damage and significantly improve quality of life. Delays in seeking medical care or stopping treatment without medical advice can allow the disease to progress and cause irreversible complications. Therefore, timely medical evaluation and adherence to treatment are essential.

Dr Aruna Caldera is an Consultant Rheumatologist

MBBS,MD, MRCP (UK) MRCP (Rheumatology)

By Zanita Careem



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Life style

Meet the author rewriting the rules of children’s fiction

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Representation matters:

By Ifham Nizam

“There are no books written about pirates with prosthetic limbs, sporting blades, or racing wheelchairs—that is, until now,” says award-winning international children’s author Jann Weeratunga, whose Polly’s Piralympics series is challenging conventional ideas about who gets to be the hero in children’s literature.

For Weeratunga, representation is not simply about placing a disabled character somewhere in a story. It is about putting that character at the centre—leading, competing, winning, making friends, overcoming challenges and, most importantly, having adventures on their own terms.

Her books are designed not merely to be read, but to be experienced. Through interactive pages, children can colour, draw, write and respond to the stories, leaving something of themselves behind as they explore themes, ranging from disability and bullying to friendship, resilience and family.

At the heart of her growing literary brand is Polly’s Piralympics, a series in which disability is not presented as a limitation, but as part of a character’s identity and adventure.

The inspiration came from an unexpected moment during the closing speech of the 2012 London Paralympic Games by Sir Philip Craven. He recalled a young boy looking at an illustration of a pirate with an eye patch, a hook, a parrot and a wooden leg.

When his mother asked who the figure was, the boy replied that because the man had only one leg, “he must be an Olympian.”

The story moved Weeratunga deeply.

That moment of innocent perception—where disability was associated with sporting achievement rather than limitation—sparked the idea of Polly and her extraordinary Piralympic world.

In the series, Polly, a bird-napped African parrot, finds herself bullied in a Scottish pet shop before being rescued by Captain Hake. Their shared one-eyed view of the world becomes the beginning of an unusual friendship. Captain Hake teaches Polly the ways of a pirate, while Polly creates the Fellowship of Pirates and the Pirates Paralympics.

Soon, pirates from around the world are competing in events ranging from three-legged races and climb-the-rigging gymnastics to walk-the-plank diving and even a MasterChef competition.

It is an imaginative world, but behind the humour and adventure lies a serious message about inclusion and leadership.

Weeratunga recalls one school visit that brought home to her exactly why the books mattered.

A student with a prosthetic leg embraced her and said: “Thank you for writing these books for me, Auntie.”

The words left her overwhelmed.

“That was why I had written these books,” Weeratunga reflects.

Her journey towards becoming an author, however, began long before Polly sailed into the world of children’s fiction.

Earlier in her life, Weeratunga was a Scout Leader in the UK, where volunteering became a way of life. She subsequently spent a decade in Sri Lanka, falling in love not only with a Sri Lankan, but with the country itself.

After her husband died just four years into their marriage, she joined five other women to establish a small school in Senarathwela to teach English to those who wanted to learn. Many of her pupils, subsequently, found employment at the newly opened Victoria Golf Course.

When she returned to Sri Lanka in 2025 and revisited the village and golf course, she found a landscape transformed by new roads, homes, shops and businesses. But the people she had taught remained.

“The village is unrecognisable, with new roads, homes, shops and businesses, but my dear pupils were still there as Caddies, Caddy Master and Golf Pro. I was so proud of them,” she says.

Her connection with Sri Lanka deepened further during one of the country’s darkest moments.

On Boxing Day 2005, while holidaying in the UK with her recently widowed mother, Weeratunga was woken by the words: “Something terrible has happened in Sri Lanka.”

She rushed to the television and witnessed the devastating aftermath of the Indian Ocean tsunami.

That very day, she established a non-profit organisation to raise funds and take relief to Sri Lanka. With support from local McDonald’s franchises, schools in Ferndown, the Mayor of Ferndown, freight companies and her friend Mr Wijekoon, a local Grama Niladhari, she helped rebuild lives in Arugam Bay.

The experience was hands-on and deeply personal. A family’s home had been swept away, and days were spent persuading surfers to help construct a future for her adopted family.

A Montessori was established on the hill, within the Buddhist temple grounds, while evenings were spent crafting, building and working with a small but effective generator.

Meals of rice and curry, prepared by the family’s sisters, using provisions donated from Senarathwela, brought the long days to a close.

When Weeratunga returned to the family, in 2025, she was able to see how far they had come.

Jann Weeratunga

Today, living in South Africa, she continues to draw inspiration from the landscape around her.

“Travelling—it leaves you speechless and then turns you into a storyteller,” she says, echoing the famous words attributed to Ibn Battuta.

And storytelling has become her way of opening conversations with a new generation.

While Polly’s Piralympics remains the flagship of her children’s publishing brand, Weeratunga’s wider collection explores a range of issues that matter to children and parents.

Terry and the Bully gives children practical and empowering ways to stand up for themselves, transforming a difficult subject into a story through which young readers can explore courage and self-confidence.

In Evie Visiting Grandma, children encounter the sensitive experience of visiting a loved one who now lives in a residential home. Rather than avoiding a potentially difficult subject, the story gently opens the door to conversations about ageing, family and change.

Terry the Toucane explores another universal childhood experience—the challenge and beauty of being different. Its central message is simple: being different should never prevent us from developing deep and lasting friendships.

Then there is Captain Bluebird, a resilient and entertaining adventure exploring what happens when Captain Bluebird receives a brand-new ship.

Across the collection, Weeratunga combines entertainment with meaningful life lessons, while her interactive approach gives children an opportunity to become participants rather than passive readers.

They can colour illustrations, draw pictures and respond to pages, making each reading experience personal.

That approach also gives the books an added value for parents and educators. They can become conversation starters—helping adults discuss subjects that children may find difficult to raise directly.

For Weeratunga, this is part of the larger purpose of her work.

Her books seek to fill a gap in children’s literature where diverse characters are not simply included for the sake of inclusion, but are given agency, personality and leadership.

In Polly’s Piralympics, disabled characters are not watching from the sidelines. They are the stars.

They lead.

They compete.

They win.

They champion their own adventures.

And that, ultimately, is the brand Weeratunga is building: children’s stories in which every child can find a place, a voice and perhaps even a little courage to become the hero of their own story.

Representation matters.

For young readers in Sri Lanka, Weeratunga’s books are now available through Sarasavi Bookshop, Vijitha Yapa Bookshop, M. D. Gunasena and Expo Graphics, Battaramulla.

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An evening where hearts sang as one

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Rajiv and Clan kept the evening alive with their vibrant music

By Zanita Careem

Music, laughter and a generous spirit filled Raflfles Hotel Colombo as Heart to Heart sing along brought together a vibrant gathering for an evening of melody, friendship and giving. The elegant ballroom reverberated with familiar lyrics as guests joined in, sang along and simply let their hair down. Adding to the infections atmosphere was the talented Rajiv and Clan, whose lively performance kept the energy soaring and had the gathering singing to some much loved favourites.

Keeping the evening moving with plenty of wit and warmth was the compere Mirzab Sherifdeen who ensured there was never a dull moment between the music, laughter and spontaneous sing-along moments, Guests were also treated to prizes galore adding an extra element of excitement to an already festive evening. There was cheers as winners stepped forward to collect their prizes, while friends and families aplauded and celebrated every winning moment.

Yet beneath all the sparkle was the meaningful purpose of Heart to Heart Trust Fund, founded by Dr. Rajitha Y de Silva and Dr. Ruwan Ekanayake, bringing people together in support of a cause built on compassion and care.

The dedications and the volunteering was evident throughout the evening with their commitment adding a special warmth to this special event.

Adding to the evening’s indulgence was a sumptous spread of cuisine by the Raffles, Hotel with an enticing selectiom that kept guests happily returning for more. From savoury favourites to tempting desserts, the food complemented the festive mood perfectly.

As the final song faded and the evening drew to a close, there was a quiet sense of gratitude. Behind the music, laughter, prizs and beautiful memories was a cause built as compassion, a cause that has continued to touch lives through the dedication of Dr. Rajitha de Silva and everyone who has stood beside him in the journey of Heart to Heart.

And as guests left Raffles Hotel with the last melodies still lingering in the air the most beautiful note of the evening remained – the sound of hearts earning for hearts. At the very heart of Hearts to Heart is Dr. Rajitha whose compassion has become the soul of the initiative. Dr. Rajitha’s work reminds us that medicine is not only about repairing what is broken. It is about giving people the courage to believe in tomorrow. And perhaps that is the greatest gift he offers. This spirit was beautifully reflected throughout the evening.It was a beautiful evening of music, friendship and generosity, with every contribution going towards a worthy cause- keeping alive a legacy built one one simple but powerful belief that every heart deserves a chance to beat on.

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Taste of Ceylon leaves a lasting flavour

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The scene at Taste of Ceylon

Taste of Ceylon opened its doors at Beira Kitchen, Courtyard by Marriott Colombo, on September 3rd; a festival of Southern, Central, Uva and Northern regional food, brought together on one table.

Four Regions, One Unforgettable Table

Each night, guests moved between four distinct culinary worlds. From the South came the deep, coconut-rich flavours of malu abulthiyal and Negombo pork curry with pineapple, alongside a lively fish polla roti action station. The Central province brought Kandalama lake fish, black octopus curry and carrot kalupol; dishes rooted in the region’s lakes and forests. Uva’s table leaned rustic and warming, with village chicken stew, prawn curry with murunga, and a coconut pittu drawing steady queues. And from the North came bold, unmistakable flavours of Jaffna crab curry, Jaffna mutton curry, and a dosai action station that quickly became one of the evening’s most talked-about corners.

Layered around the four regional stations was a spread that told its own story of Sri Lankan hospitality, from belimal herbal welcome drinks and a bread corner stretching from curry leaves rolls to kurakkan viyana rolls, to a dessert corner where watalappan, wood-apple coconut wandu and king coconut jelly sat alongside a full spread of traditional Sri Lankan sweets like kokis, athirasa and aluwa.

What the guests had to say

The feedback on opening night carried a common thread: guests were struck by just how different each region’s food tasted, side by side, on the same table. What could easily have blurred into “just Sri Lankan food” instead came through as four distinct culinary identities; the fire of the North, the coastal warmth of the South, the earthiness of the Central hills, and the rustic comfort of Uva, each unmistakably its own.

A Word from the team

Reflecting on the festival, the team at Courtyard by Marriott Colombo shared that Taste of Ceylon was designed from the start to be more than a menu. It was meant to be an experience guests could travel through, one region at a time, without leaving Beira Kitchen. Judging by the response over the four nights, that’s exactly how it landed.

There were many rave reviews and as the Taste of Ceylon experience at Beira Lake drew to a close, the flavours, aromas and vibrant spirit of Sri Lanka lingered on.

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