Lupus is a disease that involves the immune system and affects about 1.5 million Americans. Robert Ashman, MD, a rheumatologist at University of Iowa Hospitals and Clinics, talks about Lupus:
Are there different types of lupus? What are they?
The most common form is called systemic lupus. That's the one that can affect various organs in the body, including the skin. But there are other diseases that have lupus in the name that mostly involve the skin, and they're really different diseases, just carrying the same name.
What causes lupus?
Your immune system can recognize the products of bacteria and viruses and that reaction leads to inflammation and inflammation then kills the bacteria and viruses.
You also have several kinds of cells in your body that turnover rapidly, like your white blood cells, and they die and get replaced. The contents of those cells are in many ways similar to bacteria. Your immune system has worked out a very elaborate scheme to tell the difference. You produce inflammation when you need it, and you don't produce inflammation when it's just routine cell turnover going on.
There are many different ways that that complex system can break down, and when it does, the result is inflammation directed to your own body—which we call autoimmunity—and lupus is one of the most common and dramatic diseases in that category. Your bloodstream carries these inflammatory products around the body and that's why you can have inflammation in such a wide variety of places.
Who is most likely to develop lupus?
Lupus is more common in females than in males. It tends to present first more commonly between 20 and 40, so it affects younger people. But there are no firm rules and you can develop lupus as an older person or you can develop it as a child or as a teenager.
What are the signs or symptoms of lupus?
The inflammation is most serious in the kidneys, in the brain, and in the bone marrow, where you can develop a loss of certain cell types that you need. You can become anemic, for example. But there's also inflammation in the skin, in the hair, the lining of the mouth, the lining of the lung and the joints, and less commonly in several other places. No two patients are exactly alike. Frequently in a given patient, they won't have inflammation in all of these places.
How is lupus diagnosed?
Your doctor will ask you about the symptoms of lupus, the things that I just mentioned. Then he will do a physical exam and look for the signs of lupus. For example, look inside your mouth and look at your skin. There are laboratory tests that are helpful to tell whether your kidneys are working properly, whether you have enough blood cells, and also there are tests for the autoantibodies that you see in lupus. There are proteins that you make that react with your own antigens and those can help you tell whether you have lupus or one of the related diseases.
How is lupus treated?
One thing to start with it to protect yourself from the sun, some people use hats and sun blocks. We use medicines to try to tone down the inflammation or prevent the contents of our cells from becoming inflamed in the first place. The most common drug used to reduce inflammation in lupus is hydroxychloroquine or Plaquenil. It helps prevent you from making antibodies to your own cells. We also use corticosteroids and immune suppressing agents to try to control the inflammation.
Can lupus be cured?
To do that we would have to change your genes and we don't know how to do that. Lupus is what we call a multi-genetic disease. It usually takes several genes that interfere with this system I talked about. We can't cure it but we are learning how to control it, the inflammation, and the immune reaction. We still need more research to try to control it better.
What might cause a 'flare up' in a person affected with lupus?
Sun exposure is certainly on the list because that will cause breakdown of the cells in your skin and release their contents and that can stimulate a flare. There are several ways that viral infections can cause flares of lupus. There are probably other triggers that we don't understand as well.
Is UI Health Care currently involved in any research involving lupus?
Yes, my laboratory and the laboratory of Dr. Peter Leonard work on how the lupus immune reaction gets started in the first place. We have a laboratory that focuses on autoimmune skin disease in our Dermatology Department. There are several laboratories in Immunology that work on how immune reactions are controlled; the switches and the rheostats that we need to know how to manipulate in order to tone down the inflammation in lupus, so all of those research projects are pertinent to lupus.
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