Lupus: The Elusive Disease
Portia Harris, MD
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.