Why I’m worried that thousands of women may be secretly suffering with lupus without realising. If you have a combination of any of these symptoms I urge you to see your doctor: DR ELLIE CANNON

Hugh Laurie has a lot to answer for. For eight series of the hit US drama House, his brilliant but caustic Dr Gregory House would swat away any colleague who dared suggest a patient might have lupus.

‘It’s never lupus,’ he would snap. It became a catchphrase. When, in the fourth series, it finally was lupus, it was played as a punchline. Great television.

But I fear it has done patients no favours, because in real life the truth is quite the opposite. It might be lupus far more often than you realise.

Lupus, or systemic lupus erythematosus (SLE), is a condition where the immune system mistakenly targets the body’s connective tissues – essentially the glue that holds us together. This can damage just about every major organ.

It is serious and lifelong, and about nine in ten patients are women, usually first affected between their teens and forties.

Officially it strikes about one in 1,000 people in the UK, and the numbers appear to be rising. But I suspect that is only part of the picture.

When researchers in Birmingham screened thousands of women, they found lupus cases that had never been diagnosed, and estimated the true rate could be almost four times the number of known cases. Even those who do get answers wait an extraordinarily long time.

A survey of more than 2,500 members of the charity Lupus UK found it took an average of six and a half years from first symptom to diagnosis, and almost half were initially told they had something else.

Worse, things are not improving. Research by Swansea and Cambridge universities last year put the average delay at seven and a half years, with those diagnosed recently waiting longer than patients in the 1990s. One waited 40 years.

Women fare worst. A study of more than 6,600 people with autoimmune diseases including lupus, published last month, found women were almost 50 per cent more likely than men to have their symptoms wrongly put down to a mental health problem. Most men were diagnosed within three months. For women, it was typically one to two years.

Why is lupus so easily missed? Because it looks different in every patient, and its early signs are the stuff of everyday GP appointments: crushing fatigue, feeling generally unwell, swollen glands and aching joints.

It’s all too easy to blame stress, the menopause or a busy life. Patients in the Swansea study described being told they had anxiety, depression or were ‘overdoing it’.

The joint pain is distinctive: stiffness, especially first thing in the morning, but usually without the swelling seen in other types of arthritis.

Then there are the more telltale signs: a butterfly-shaped rash across the cheeks and nose, hair loss, chest pain, eye problems and a dry mouth. It’s the combination that matters. One symptom alone could be anything. Several together should ring alarm bells because, untreated, lupus often gets worse over time.

Within five years of symptoms starting, it can cause serious and often life-changing damage to a major organ such as the kidneys or heart.

In 2017, the US pop star Selena Gomez had to undergo a kidney transplant as a result of organ failure triggered by lupus.

It also raises the risk of blood clots, strokes and heart attacks, meaning lupus patients, on average, die younger than those who do not have the condition.

The good news is that the tests are simple and available at your GP surgery. Blood tests can reveal inflammation and, crucially, antibodies set off by lupus. Anyone who experiences a cluster of these symptoms should ask to be tested for lupus.

Today a cornerstone of NHS treatment is hydroxychloroquine, an anti-malaria tablet, alongside steroids and biologics – modern drugs that target specific errors in the immune system.

One of these is called belimumab, which, in 2011, became the first new lupus medicine in more than 50 years.

The only downside is that many of these medicines can weaken the immune system, so it is important that patients are up to date on their vaccines.

But none of these medicines can help if no one thinks to look. So, with apologies to Dr House: sometimes, it really is lupus.

Sick note culture is not fit for purpose

I was encouraged to read about plans to ban young people from going on long-term sickness benefits based only on a sick note from their GP.

Known as ‘fit notes’ in the NHS, the system has come under intense scrutiny in recent years because figures show that 93 per cent of the millions written every year lead to Britons getting time off work. This is not a good use of GP time – nor is it good for our patients in the long-run. Of course, there will always be some young people struggling with serious, chronic conditions that make it difficult for them to work.

But, for most, the benefits of going to work will always outweigh the negatives. Employment provides routine, socialising and, of course, financial security.

Your questions answered

I suffer from terrible ear wax but I’ve been told Q-tips are dangerous. Is it worth paying to get them cleaned? 

Dr Ellie replies: Having ear wax is normal – and there are only a few scenarios in which it is worth having it removed.

The wax itself is not a medical issue. We are supposed to have it. It protects the ear canal, by keeping the skin and eardrum moisturised and by protecting against infections. Removing it too often can damage the skin or increase the risk of an ear infection.

Moreover, GPs now advise patients not to use Q-tips to clean out their ears. This is because, inserted too far into the ear, the cotton bud sticks can damage the eardrum.

Normally, the body is able to clear ear wax on its own.

Ear wax is only a problem if it is causing deafness, itchiness, pain or the ear feels blocked. This can be a sign that a build-up has occurred that the body cannot clear.

In this situation, the best option is softening drops. These are drops placed in the ear, which moisten the ear wax, allowing it to drain out.

Softening drops are often made using olive oil, almond oil or sodium bicarbonate. These can be bought over the counter at most high street pharmacies.

If this doesn’t work, then it might be worth paying for the wax to be removed at a private clinic. This is normally done using a tiny suction device or with a water jet.