Urban Housecalls: Lupus
Saturday, September 24, 2011

By Portia Harris, MD

Could It Be Lupus?

A 30 year old mother of two has been having joint pains and chest pain for several years.  She has been to several doctors for her symptoms and had numerous ER visits.  She also had a miscarriage when she was in her mid-twenties.  On her last visit to the doctor she was referred to a rheumatologist for further evaluation because she had an unusual rash on her face that resembled a butterfly.  At the rheumatology appointment she finally gets a diagnosis of lupus.

This is not an uncommon scenario for many people living with lupus.

Lupus is an autoimmune disease that occurs when the immune system becomes overactive.  As a result, damage can occur in the tissues of the brain, heart, lungs, skin, kidneys, and joints.  There are three forms of the disease.  They include systemic, discoid, and drug-induced.  Systemic disease can be widespread affecting several organs, whereas discoid lupus is mainly a skin disease.  Drug induced lupus is caused by certain medications used to treat conditions such as hypertension or high blood pressure.

Lupus is a potentially dangerous disease that can affect anyone, though primarily affecting African American women at staggering rates.  Approximately 90% of those living with lupus are women, and it is estimated that 1 in 250 African American women have the disease.

Symptoms of systemic disease include facial rash that resembles a butterfly (malar rash), hair loss, nose and/or mouth ulcers, joint pain with swelling, sun sensitivity, blood clots, seizures, dry eyes, anemia and depression.    People with lupus may also have blood or protein in the urine found on routine urine screenings.  It is also possible for people living with lupus to experience white to blue to red color changes in the fingers during cold temperatures.  This is known as Raynaud’s phenomenon.  Women with lupus may also experience multiple miscarriages or difficulties during pregnancy.  The presence of these symptoms plus blood tests that indicate the presence of lupus antibodies will confirm the diagnosis.

The cause of the disease is unknown.  This disease tends to cluster in families.  Therefore, there is a genetic predisposition.  There are also environmental factors that may trigger symptoms.  It is thought that hormonal factors may play a role in exacerbating the disease.

Treatment targets the immune system.  The goal of treatment is to prevent organ damage.  These include steroid drugs, NSAIDs (naproxen, ibuprofen, etc.) and anti-malarial drugs.  Immunosuppressive drugs are also used.  These are medications that suppress the immune system and help stop the inflammation that occurs.  People with lupus are treated by specialty physicians called rheumatologists.

Many patients with lupus have active, productive lives.  If you have been diagnosed with this disease, be sure to talk with your rheumatologist to ensure your treatment plan is effective.  Always adhere to your medication regimen.  There are many resources to help you including The Lupus Foundation of America and The Arthritis Foundation.  For more information visit http://www.lupus.org/newsite/index.html.

Dr. Harris is a rheumatologist in Hattiesburg, Mississippi.  She is board-certified in Internal Medicine and Rheumatology.

Urban Legends:Lupus

1.      There is no treatment for lupus.  While there is no cure, there are plenty of treatments available to help with the symptoms of the disease and to help prevent “flare ups”.  If you have a diagnosis of lupus, be sure to consult with your rheumatologist to make sure your treatment regimen is effective for you.
2.      Women with lupus should never get pregnant.  This is not true.  While some women with lupus do have difficulty getting pregnant, or may suffer some lupus related pregnancy complications, an overwhelming majority of women with lupus go on to have successful pregnancies and deliver healthy babies.  Be sure to consult with your physician if you are considering pregnancy to make sure you are at your best health prior to conception.
3.      Lupus is a disease that only affects women.  This is a common misconception.  While an estimated 90% of lupus patients are female, there are some men that suffer from lupus as well.  Anyone with symptoms of unexplained joint pain, rash, fatigue, blood clots, etc. should be checked for lupus.
4.      If I am not currently having symptoms of my lupus, I don’t need to take any medicine for it.    This is not true.  Lupus is a disease that can affect many areas of the body both internally and externally.  Often times there can be high levels of inflammation well before symptoms are seen.  It is never a good idea to stop your treatment without discussing your concerns with your healthcare provider, even if you aren’t having any symptoms.

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This was printed in the September 25, 2011- October 8, 2011 Edition.


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