Information about lupus, per request
Monday, September 02, 2013 10:00 PM
I had a request to write about lupus. Lupus is the shortened name of Systemic Lupus Erythematosus. It is an autoimmune disease first described by the physician Rogerius in the 12th Century. There are many opinions regarding the origin of the name "lupus." One of the most popular is that the rash on the face of many lupus sufferers resembles a wolf's face. Lupus is the Latin word for wolf.
Dr. John Roberts is a Crawfordsville physician and one of the owners of The Paper. In addition to his weekly column, he writes a daily health tip that can be found on page A1.
Autoimmune diseases are a group of illnesses caused by a person's immune system attacking their own body. In the case of lupus, the immune system makes antibodies against proteins in the nuclei of cells, where the DNA is found. It is believed that people who develop lupus have an underlying genetic predisposition to the disease. There is no single "lupus gene." It appears to involve problems with multiple genes.
Certain environmental factors are felt to trigger damage to cells that allows the immune system to be exposed to proteins that are normally hidden in the nucleus. Some of the factors causing damage are thought to include ultraviolet light, stress, medications, and infections (likely by viruses). Drug-induced lupus usually goes away when the offending medication is stopped.
It is estimated between 270,000 and 1.5 million people have lupus in the United States. It is more common in young women, who develop it about ten times more often than men. It is usually diagnosed between the ages of 16 and 55 and is more common in African, Hispanic, Asian and Native American populations. Some of the risk factors for lupus include being related to someone with it (5 to12 percent chance), smoking, sun sensitivity, and post-menopausal estrogen replacement therapy.
Lupus is known as the "great imitator" because it can present with signs and symptoms found in many other diseases. This makes it difficult to diagnose and accounts for an average delay of five years between onset and diagnosis. It is characterized by flare-ups of disease activity followed by remissions.
The most common signs and symptoms of lupus include joint pain (especially the hands, wrists and knees), fever, malaise, rashes, muscle pain, fatigue and weight loss. Some women report flares after ovulation and improvement with menstruation.
Since lupus involves an immune response, it can affect every organ system in the body. The most commonly affected organs include the heart, joints, skin, lungs, blood vessels, kidneys and nervous system. Joint involvement is present in about 90 percent of patients. The typical lupus rash is found on the cheeks and nose but can also present with scaling lesions elsewhere. Some people develop severe inflammation of the heart, kidneys or lungs.
The diagnosis of lupus is very difficult. A patient has to have at least four of eleven symptom criteria either together or serially. Each of the eleven criteria has varying specificity (if present the disease is likely) and sensitivity (if absent the disease is unlikely) for diagnosing lupus.
There are also laboratory tests that can help confirm the diagnosis. The most common is the ANA or Antinuclear Antibody test. If this test is negative, the likelihood of lupus is very low. If it is positive, confirmatory tests that look for antibodies to proteins in the nucleus are often done.
There is no cure for lupus, so the goal of treatment is to prevent flares and shorten the duration and severity of symptoms. There are many types of medications used. The first line drugs are non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and Aleve. If those fail or more severe symptoms develop, stronger medications can be used to suppress the immune system.
There are also lifestyle changes that can reduce symptoms or limit flares. Patients should avoid direct sunlight and wear a good sun block. Smokers should quit and those who are obese should lose weight to reduce stress on their joints.
The prognosis for lupus has improved dramatically. In the 1950's almost all patients died within five years of diagnosis. Patients can now expect to live five years 95 percent of the time. Most who die of lupus do so from infections from damaged organs or immune suppression from medications.