A Look at lupus

Dr. Norman B. Gaylis

SLE, (systemic lupus erythematosus), commonly known as lupus, affects more than half a million people in the United States. This illness is most common among women of child bearing age, however, it can affect females of any age as well as males. Despite the large number of lupus sufferers, there are still many misconceptions about this disease. In particular, there is a sense of panic when people hear the word lupus and I hope this article will help clarify that the majority of patients with lupus are well controlled and treatable. In the presence of a responsible patient and knowledgeable physician, the outcomes are more often good than bad.

SLE is an autoimmune condition which, by definition, implies that the individuals own natural antibodies start reacting and rejecting their own natural, normal tissues and organs. This may occur in varying degrees involving either one area of the body or multiple areas and, dependent on the areas involved, the symptoms and physical findings range from mild to diffuse. The most common areas affected are the skin, joints, blood, kidneys and central nervous system.

SLE is a chronic condition which usually will last a lifetime. There may well be long periods of remission in-between flareups and, in fact, the primary aim of treating SLE is to induce remission, that is a period of inactivity of the disease.

The most common symptoms of lupus patients include overwhelming fatigue often in the absence of other findings; pain and stiffness of the joints; skin rashes which typically are photosensitive, that is they are extremely reactive to sun exposure which needs to be avoided in lupus; hair loss; mucosal ulcerations and Raynaud’s phenomenon are amongst other complaints which will vary from organ to organ, depending on involvement.

The most important thing in treating the lupus patient is to diagnose the condition as soon as possible. This is based on a combination of physical symptoms and findings, and blood tests, which include antibodies such as the ANA and anti-double stranded DNA antibodies which are required to confirm the diagnosis. A pertinent point is that a positive ANA by itself does not establish the diagnosis of lupus and can, in fact, be found in many individuals with no other consequences and no diagnosis of lupus being present.

There are many forms of therapy available. Prior to treatment, the most important part of therapy is to make sure the patient understands the do’s and don’ts that aggravate this condition_ Avoiding the sun and reducing stress in particular are critically important. Hormonal variations can affect this disease as can certain other medications. The most common medication used to induce remission is Prednisone, a form of cortisone. This drug, when used judiciously, has far more benefits than side effects. However in addition, we have immunosuppressive drugs such as Imuran, Methotrexate and Cyclophosphamide which may allow one to suppress the lupus and reduce the dose required of Predisone. All of these drugs have side effects and, obviously, this needs to be weighed against the benefits which is not difficult to do. Another important drug in the treatment of lupus is Hvdroxychloroquine, or Plaquenil, which in particular is very valuable in treating the skin and hair manifestations of lupus.

All patients with lupus should see a specialist in this disease, a rheumatologist. The treatment outcome for lupus today is far brighter than it ever was in the past. If you have any questions with regard to the possibility of this diagnosis existing or how to treat it, please do not hesitate to contact me or an expert in the field.