Massachusetts Medical Society's Physician Focus

June 2012

Understanding Lupus

PROGRAM HIGHLIGHTS:

  • Lupus is a chronic, inflammatory disease of the immune system that can attack various parts of the body, such as the skin, joints, or internal organs.

  • At least one and a half million Americans have the disease, with more than 16,000 new cases reported each year.

  • Ninety percent of those affected are women, with most between the ages of 15-44.

  • Patients with advanced cases of lupus may see an increased risk of heart disease, osteoporosis, or kidney disease.

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It has been called America’s “most-common, least-known” disease, and at its most basic, it can be described as your own immune system attacking your body. It can affect any organ in the body and become worse over a long period of time.

“Lupus is a condition where your immune system attacks your body. It’s almost like being allergic to yourself,” says Martin Kafina, M.D. “Your immune system is supposed to be your friend and clean out your blood from viruses, germs and cellular debris, but instead your immune system gets irritated and confused and reacts against yourself. It can cause quite an amount of distress and sickness.”

Dr. Kafina, a clinical instructor in medicine at Harvard Medical School at Beth Israel Deaconess Medical Center who specializes in the private practice of rheumatology at Emerson Hospital in Concord, Massachusetts, discussed the many and varied aspects of lupus with program host Bruce Karlin, M.D. on the June edition of Physician Focus with the Massachusetts Medical Society.

One of the causes of systemic lupus erythematosus – its formal name - is the body’s white blood cells, which secrete antibodies intended to clean out a person’s blood system. In the process of doing that, however, the white cells secrete bad antibodies, which lead the immune system to react against itself, causing the condition. But lupus is a complex condition and can include other triggers as well. Environmental factors, ultraviolet radiation, hormonal conditions, genetics, and trauma may also play roles. Certain drugs can trigger the immune system, causing a different form of the condition: drug-induced lupus.

Part of the mystery of lupus, says Dr. Kafina, is that it can look like many other conditions and present differently in different patients. One patient can have a mild case, another may have a severe case, and there’s a large spectrum in between. Some patients can go for years and see many doctors before being diagnosed correctly.

The American College of Rheumatology has developed 11 common criteria for the condition. If a patient has four of the 11 (among them: fatigue, anemia, low white count in blood, seizures, rashes, hair loss, sensitivity to light, oral blisters, arthritis, chest pain, inflammation of the lining around the lung), then it’s quite possibly lupus. A specific blood test for lupus - an antinuclear antibody test – would indicate the condition.

Lupus is predominantly a disease of women – 90 percent of those affected are females15-44 – and several theories exist as to why that is the case, including the presence of estrogen. But children and men can also be affected, and in men it can be severe.

Treating the condition involves multiple approaches. A healthy lifestyle is key, says Dr. Kafina, because “the more stressed out your immune system is, the more aggressive the condition might be.” He says it is extremely important to eat properly, get enough sleep, keep stress levels under control, and get regular, gentle exercise.

The drugs used to treat lupus include anti-malarials, steroids, and anti-inflammatories – medicines generally prescribed for other conditions. The first new drug developed for lupus in more than 50 years, Benlysta, appeared just about six months ago. While not enough research has been conducted on lupus, Dr. Kafina says there is a huge explosion of immunologic research now ongoing, which should prove beneficial for future treatments.

His advice to patients? If you have unexplained conditions, or signs and symptoms that don’t seem to make sense, talk with your primary care physician and schedule a visit with a rheumatologist. It’s important to try and diagnose lupus early, because delay can result in serious conditions like kidney disease or heart conditions.

Watch the accompanying video for additional conversation about the difficulty of diagnosing lupus, theories about why lupus is predominantly a disease of women, how the disease is treated, and when a patient should see a rheumatologist, a physician who specializes in treating diseases of the joints and muscles.

Text:
MMS/Richard Gulla

ADDITIONAL RESOURCES
American College of Rheumatology

Lupus Foundation of America

U.S. Health and Human Services: Women’s Health

Centers for Disease Control

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Lupus PSA


From left: Bruce Karlin, M.D., Martin Kafina, M.D.
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