Lupus affects nine times as many women as men. It may occur at any age, but appears most often in people between the ages of 10 and 50 years. Robert Ashman, MD, former director of rheumatology in the Department of Internal Medicine at University of Iowa Hospitals and Clinics, talks about lupus:
What is lupus?
The term lupus usually refers to systemic lupus erythematosus, SLE, which is an inflammatory disease that can affect almost any part of the body because it causes inflammation in the blood vessels. In lupus, what happens is that the mechanisms that we use to defend ourselves from bacteria and viruses (the inflammatory mechanisms) get turned on inappropriately without an infection and then you have to combat it with medicines.
Are there different types of lupus?
The word lupus appears in the name of several different diseases, but when we use it alone, it usually refers to the disease I mentioned above – SLE.
What causes lupus?
It’s a combination of susceptibility genes, your heredity, and life events that happen. Research is turning up a short list of genes that cause increased susceptibility to lupus in various ways. Most people with lupus will have several of those genes, but of course they won’t have all of them. If you have the genes, that doesn’t necessarily mean you get sick, unless something else happens to you – like you get a bad sunburn and kill a lot of skin cells or you get certain kinds of viral infections and that kills cells. And there’s a particular kind of cell death that will release the molecules that trigger the immune response in lupus.
Why are women much more likely to develop lupus?
It seems that estrogens in particular among the sex hormones have an effect of making the cells of the immune system more susceptible to being activated. And that applies also to the inappropriate activation that happens in lupus. The male hormones have the opposite effect.
What are the symptoms of lupus?
Well, they’re all over the body. Like I mentioned, you can have sun-sensitive skin rash, joint pains, inflammation of the lining of the lung (we call that pleurisy), sores in the nose and mouth, lose hair, trouble with your kidneys and blood cells. And in general, no one patient will get all of these symptoms and that’s why we say no two patients with lupus are exactly alike.
How is lupus diagnosed?
It’s the constellation of different features, and you learn it from taking a careful history from the patient – see if they have the symptoms that I mentioned. The physical exam will turn up the rash and swollen joints. Then you have to do some lab tests to check for the blood cell problems, the kidney problems, and the autoantibodies.
What does the antinuclear antibody blood test mean, in the diagnosis of lupus?
The antinuclear antibody (ANA) test is abnormal in lupus, almost in every case. But it’s also abnormal in several other diseases. It’s an important test, mainly because if you suspect lupus and the ANA is negative, that’s a very strong argument that the patient doesn’t have lupus, but has something else. Now occasionally you’ll find somebody who has a few of the signs of lupus but maybe not enough to be convincing and then having a positive autoantibody test strengthens the case for lupus. However, if there are no other signs for lupus present, a positive ANA doesn’t mean anything.
How is lupus treated?
There is no one treatment for every patient with lupus. Treatment involves the use of anti-inflammatory medicines and they depend on which organs are involved and how severe the inflammation is. So we try to use the gentlest anti-inflammatory that will work in the given patient. If all you have is pleurisy and arthritis, you’ll get a gentle medicine; but if you’ve got a severe kidney disease, you’ll get a very strong one, instead.
Is a person diagnosed with lupus a patient in more than one specialty clinic?
That’s common in lupus. For example, if you have mainly joint and kidney trouble, you might see the rheumatologist and the nephrologist (the kidney doctor). On the other hand, if your main problem was seizures and skin rash, then you’d likely get your care from a neurologist and a dermatologist. And of course the doctors need to talk to each other in order to develop a common treatment plan for you.
Can lupus be cured completely?
We can certainly knock down the inflammation with our medicines, and commonly, when you have a flare of lupus, you’re going to be on anti-inflammatory medicines for several months and maybe a couple years. Then we can slowly reduce the medicines and frequently the patient can get off medicines and not need them for an extended period. Then a few years later, they’ll have another flare. So it’s very hard to be certain, even if you get a great response to the medicines, whether you’ve cured the disease. The disease susceptibility, at least, remains because you haven’t changed the patient’s heredity.
Will lupus shorten the lifespan of the individual who has it?
It can, in rare cases, shorten the lifespan directly. For example if you have a severe brain disease and we have trouble controlling it. But usually the shortening of the lifespan in lupus is due to infectious complications or to heart attacks and strokes from all the information in the blood vessels.
Is University of Iowa Hospitals and Clinics involved in any research with regard to treatment or cure for lupus?
Yes, we have some research that’s pertinent to lupus. To illustrate how basic research comes first and is the basis for developing new treatments, I can tell you just a little bit about what we’re doing in our laboratory. About a decade ago we were studying cell death mechanisms. And then another laboratory showed that the cell death mechanism we were studying actually provided the molecules that drive the autoimmune response in lupus. Then we developed little bits of DNA, the hereditary materials (synthetic bits) that are inhibitors of this response and now we and other laboratories are using them in inbred mice that develop lupus and showing that they decrease lupus and help to prevent aspects of lupus. So obviously we’re hoping that this trail will end in a clinical trial some day. |
