September 3, 2005
Damaging Effects of Lupus
Q: I have had lupus for many years, with flare-ups and remissions. Is there anything new I can do to keep this disease in check?
-- L.K., Stamford, Conn.A: Systemic lupus erythematosus (SLE), or lupus, is an autoimmune disorder of unknown cause. Autoimmune means that a person's own immune system attacks and damages healthy tissues.
The autoimmune reaction in lupus is characterized by inflammation. Unfortunately, with lupus the inflammation is long- term and results in damage to normal tissue. Lupus usually affects multiple organ systems (hence the "systemic"), often beginning with the skin and joints.
The kidneys are particularly susceptible to this disease, and damage of these organs is a major cause of illness and death in people with lupus. Also, people with lupus have a much higher risk of developing atherosclerosis and its complications.
Early symptoms associated with lupus can include skin rash, including a characteristic butterfly-shaped redness on the face. The rash is usually confined to areas of the skin exposed to sunlight.
Later in the course of the disease, the symptoms of lupus can include pleurisy, blood abnormalities, and problems with the kidneys and nervous system.
Diagnosis is often difficult because lupus can resemble many other disorders, such as rheumatoid arthritis, vasculitis, scleroderma and hepatitis. Drugs such as procainamide, hydralazine and isoniazid may also cause lupus-like symptoms but do not cause lupus itself.
Researchers discovered last year that looking for high blood levels of one protein (erythrocyte-C4d) combined with low levels of another protein (erythrocyte-CR1) is a highly sensitive test for lupus.
It's always a good idea to be sure of the diagnosis, preferably after having an exam done by a specialist like a rheumatologist or dermatologist. Early, accurate diagnosis and treatment are critical to prevent scarring, pain and organ involvement associated with this autoimmune disorder.
People with lupus should limit their exposure to sunlight by using sunscreen and protective clothing such as hats.
Specific treatment depends on which organ systems are affected and whether the disease is mild or severe. When symptoms and organ involvement are mild, a person may choose only to use aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Topical steroids may help with skin problems.
To treat more severe symptoms and to prevent further damage to major organs, drugs for treating lupus include corticosteroids, antimalarials, and immunosuppressants. However, all of these drugs can have significant side effects.
There is some potentially exciting research on treatment of lupus that has been reported over the last year. This includes the use of stem cell transplants and the use of mycophenolate mofetil, which is a drug that is now used to prevent the rejection of transplants.
Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y. 14207; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.