Lupus, while challenging, can be treated

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10/27/2006

Lupus, while challenging, can be treated

By: Leonard Grossman, M.D. , Special to The Packet

The disease can strike people of all ages, but it is most frequently

diagnosed between the ages of 15 and 45

Lupus is the name of a chronic autoimmune disease that causes

inflammation in various parts of the body, including the joints,

skin, heart and lungs, kidneys and blood cells.

The immune system is the body's main defense against harmful

bacteria and viruses, but in people who have lupus, the immune system

attacks healthy tissue, as well. This is the meaning of autoimmunity.

Lupus is not a disease that is directly inherited through the

genes. In fact, only 5 percent of children born to a parent who has

lupus will develop the disease. But doctors believe that certain

genes make certain people more susceptible to the disease, and having

a relative who has lupus can increase the odds of developing it.

Medical research suggests that exposure to other environmental

factors can trigger lupus. Such triggers might include viral or

bacterial infections, long-term use of certain prescription drugs,

and ultraviolet radiation found in sunlight. Another factor could be

hormones, particularly estrogen, which may explain why the majority

of people afflicted with lupus, about 90 percent, are women.

The disease can strike people of all ages, but it is most

frequently diagnosed between the ages of 15 and 45. It affects 1 in

4,000 people in the United States. The outlook for people with lupus

was once very grim. Today, with early diagnosis, proper care and new

medicines, most people with lupus can lead active, normal lives.

The most common symptoms of lupus typically develop at intervals,

rather than appearing all at once, and can get worse in episodes

called " flares. " The symptoms might improve or even disappear

completely for long periods of time, going into remission.

Lupus can be hard to diagnose because it often mimics other

illnesses that are not as serious. It's been called a disease " with a

thousand faces " because it manifests in different ways from person to

person. Symptoms can start with fatigue, fever and joint pains. The

overwhelming majority of patients will have joint and/or skin

involvement within the first year of their disease.

There is no single laboratory test yet developed that can

diagnose lupus. The American College of Rheumatology (ACR) has

developed a set of criteria to help doctors diagnose lupus. The ACR

says having 4 of the 11 criteria at one time or over a period of time

means a diagnosis of lupus is likely and medical attention should be

sought immediately.

" Wolf Bite " or Malar rash: One in 3 people with lupus develops a

distinctive rash that doctors once thought resembled a wolf bite,

hence the name lupus, which is the Latin word for wolf. The rash

develops across the cheeks and bridge of the nose and is butterfly-

shaped.

Discoid rash: raised, scaly patches on the skin anywhere on the body.

Photosensitivity: These rashes can become severe when the skin is

exposed to the sun or even harsh indoor lighting, such as fluorescent

bulbs.

Oral ulcers that last for more than two weeks.

Arthritis: The areas afflicted are primarily the knees, wrists,

fingers and hands, which can swell and have joint pain.

Kidney Problems: Lupus can wreak havoc on the kidneys by causing a

condition that affects their ability to filter toxins.

Glomerulonephritis can lead to kidney damage and can eventually lead

to kidney failure. Fortunately, this is uncommon, and medication can

prevent or delay its occurrence.

Brain/Central Nervous System Problems:, Lupus can affect the brain

and central nervous system with symptoms that can range from

something as mild as a headache to dizziness, vision problems,

seizures and stroke.

Heart/Lung Problems: One of the most serious symptoms of lupus is

pericarditis — inflammation of the pericardium, the sac surrounding

the heart. This condition can cause shortness of breath and chest

pain. Lupus can cause an inflammation of the chest cavity lining

known as pleurisy. It can also cause pulmonary hypertension — high

blood pressure in the lung's blood vessels.

Blood Disorders, including anemia, low platelets or a low white cell

count.

Anti-nuclear antibody: This test, often called the ANA, is present in

more than 95 percent of patients with lupus. Unfortunately, patients

with other autoimmune diseases and even some healthy people can have

an ANA.

Immunological Disorder: an indication of an autoimmune disease.

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There are certain health risks posed by lupus, especially for

younger women in their childbearing years. Women with lupus have a

higher risk of miscarriage. They are more likely to experience a

flare-up during their pregnancy. They are also at greater risk of pre-

term birth and other complications while they are pregnant, including

diabetes, kidney problems and high blood pressure. Women with lupus

have an increased risk of infection from the intrauterine device

(IUD) and may have a low tolerance for birth control pills.

Lupus can result in permanent tissue and organ damage because the

early warning signs and symptoms are so often overlooked or

misdiagnosed. Early diagnosis and treatment is critical because it

can cut the time needed to take higher doses of medications which can

cause serious side effects.

People with lupus can reduce the length and severity of their

flares by learning to recognize the warning signs and getting

adequate amounts of rest, staying out of the sun, getting exercise,

eating well and limiting stress. Staying away from alcohol and

cigarettes also help.

With the right care, better methods of therapy, increased

awareness and early intervention, 80 to 90 percent of people today

with non-organ-threatening lupus can look forward to a normal life span.

To find out more about lupus, visit the Lupus Foundation of

America at www.lupus.org or the Alliance for Lupus Research at

www.lupusresearch.org. To find a Princeton Healthcare System

rheumatologist, visit www.princetonhcs.org or call (888) 742-7496.

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