Although Lupus Awareness Month is in May, the impact of the disease can be felt year-round. And as fall weather rolls in, many of those who have lupus can start to experience flare-ups.
According to the Lupus Foundation of America, lupus is a chronic, autoimmune condition that can damage any part of the body (skin, joints and/or organs inside the body). “Chronic” means the signs and symptoms tend to last longer than six weeks and often for many years.
In lupus, something goes wrong with your immune system, which is the part of the body that fights off viruses, bacteria and germs (“foreign invaders” like the flu).
The lupus foundation also states that approximately 1.5 million people in the United States have lupus. People of African, Asian and Native American descent are more likely to develop lupus than Caucasians.
Although it can occur in both men and women, 90 percent of people diagnosed with the disease are women.
The cause of lupus is unknown. However, there appears to be something that triggers the immune system to attack various areas of the body. Some of the more common symptoms include:
• Achy joints (arthralgia)
• Unexplained fever (more than 100 degrees
Fahrenheit)
• Swollen joints (arthritis)
• Prolonged or extreme fatigue
• Skin rash
• Ankle swelling and fluid accumulation
• Pain in the chest when breathing
deeply (pleurisy)
• A butterfly-shaped rash across the
cheeks and nose
What problems can people
with lupus have?
Many people with lupus feel ill in general and complain of fever, weight loss and fatigue. The following areas of the body can be affected by lupus:
• Skin: Skin problems are a common feature of lupus. Some people with lupus have a red rash over their cheeks and the bridge of their nose called a “butterfly,” or malar, rash. Other types of rashes may occur elsewhere on the body.
• Joints: Arthritis is very common in people with lupus. There may be pain with or without swelling.
• Blood: Those with lupus may have dangerous reductions in the number of red blood cells, white blood cells or platelets.
• Brain and nerves: Depression and memory problems are common in people with lupus.
• Heart and lungs: Some people with lupus can develop inflammation in or around the heart and lungs.
How is lupus diagnosed?
Lupus can be difficult to diagnose, and should be confirmed by a specialist trained in rheumatology. There are many other conditions that can mimic lupus that need to be ruled out.
The American College of Rheumatology has devised criteria to help doctors make the correct diagnosis of lupus. A person should have at least four of the following 11 criteria, either at the same time or one after the other, to be classified as having lupus. These criteria include:
1. Malar rash: A “butterfly” rash that appears
on the cheeks
2. Discoid rash: Red, scaly patches on the skin
that cause scarring
3. Photosensitivity: A skin reaction or sensitivity
to sunlight
4. Oral ulcers: Open-mouth sores
5. Arthritis: Pain, inflammation or swelling of
the joints
6. Kidney disorder: Either excess protein in the
urine (proteinuria) or red blood cells in the urine
7. Abnormal lab testing: A significantly elevated
ANA (antinuclear antibody) test
8. Other abnormal lupus-specific lab tests
9. Low blood counts
10. Nervous system problems such as seizures
11. Serositis: Fluid/Inflammation in the lining of
the heart or lungs
How is lupus treated?
The type of lupus treatment prescribed depends on several factors, including the person’s age, type of drugs he or she is taking, overall health, medical history and location and severity of disease.
Some treatments for lupus include:
• Steroids: Steroid creams can be applied directly to rashes. Tablets taken by mouth can also be effective for mild or moderate features of lupus. Steroids can be used in higher doses when internal organs are threatened. Unfortunately, high doses also are most likely to produce side effects.
• Plaquenil (hydroxychloroquine): A drug commonly used to help keep mild lupus-related problems such as skin and joint disease under control. It is also effective at preventing lupus flares.
• Methotrexate: A low-dose chemotherapy drug that is effective at treating more severe types of arthritis associated with lupus.
• Imuran (azathioprine): A medication that was originally used to prevent rejection of transplanted organs. It is commonly used to treat the more serious features of lupus.
• Cellcept (mycophenolate): Another medication that was originally used after organ transplant. It is most commonly used to treat kidney involvement in lupus.
• Cytoxan (cyclophosphamide): A chemotherapy drug that has very powerful effects on reducing the activity of the immune system. It is used to treat severe forms of lupus such as those affecting the kidneys or brain.
• Benlysta (belimumab): A newly FDA-improved medication that blocks one small part of the immune system that causes problems in lupus.
There is no cure for lupus, but there are steps you can take to improve your sense of well-being and your quality of life:
• Exercise.
• Get enough rest.
• Eat well.
• Avoid alcohol.
• Don’t smoke.
• Work closely with your rheumatologist and
other health care providers to treat and watch for problems related to lupus.
Dr. Allyson McDonough is a board-certified rheumatologist at Scott & White Healthcare - Round Rock. She is currently accepting new patients, and is coordinating clinical research trials studying new medications for the treatment of lupus. For more information, please call 512-509-0200.
