Lupus: The Great Imitator

Most people with the disease can lead normal, high-quality lives, despite their symptoms and the potential side effects of treatment.

Lupus is a disease that has been chronicled since the days of Hippocrates. Though modern science has identified it as a chronic autoimmune disease, there is still no cure. In lupus, as in other autoimmune diseases, the immune system malfunctions, producing autoantibodies that react with and damage the body’s own healthy cells, tissues, and organs. This leads to inflammation that is the cause of numerous symptoms, the most common of which include extreme fatigue, painful or swollen joints, unexplained fever, skin rashes, and kidney problems.

Anyone can get lupus and, according to the FDA, about 25,000 new cases are diagnosed every year. However, 90 percent of new cases develop in women age 15-45, in their childbearing years. The disease is more common in women of African-American, Hispanic, Asian, and Native American descent than in Caucasian women. It is believed that hormones influence the probability of developing the disease, as well as genetic predisposition and environmental factors, but all the contributing factors have not yet
been pinned down.

There are several types of lupus. The most common form, called systemic lupus erythematous, can affect numerous bodily organs—such as the kidneys, lungs, heart and brain—as well as the joints and skin. Discoid lupus is a chronic skin disorder characterized by a red, raised rash on the face, scalp, or elsewhere that can last from days to years and may cause scarring. Subacute cutaneous lupus causes skin lesions on parts of the body exposed to sun. Drug-induced lupus is caused by medications—such as antiseizure, high blood pressure and thyroid medications, and by antibiotics and antifungals—and typically goes away when the drug is stopped.

Diagnosing lupus is often a challenge. The symptoms of the disease mimic those of many other conditions and each patient has slightly different symptoms that may come and go over time. Diagnosis is based upon a complete medical history of signs and symptoms, physical exam and laboratory tests. There is no single test that determines whether a patient has lupus. But, considered in total, blood counts and tests for autoantibodies (such as the ANA, anti-DNA, anti-Smith, etc.) can help your rheumatologist confirm or rule out lupus.

Treatment plans, which are tailored to the individual patient, have several goals: prevention of disease flares; treatment of flares when they occur; minimizing organ damage and complications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are often used to reduce inflammation and resulting pain and swelling. Corticosteroids, such as prednisone, may be prescribed to rapidly suppress inflammation and reduce immune system activity.

For almost seventy years, the most commonly used medication for lupus has been Hydroxychloroquine (Plaquenil), an anti-malarial drug that can keep the disease in remission and may decrease the risk of lupus spreading to the internal organs. If this drug does not provide sufficient relief, or if there is internal organ involvement, newer potent immunosuppressants, such as methotrexate, azathioprine, or cyclophosphamide, may be prescribed.

The newest medications for lupus are biologic agents. The first drug specifically developed to treat lupus, Benlysta, was approved by the FDA in 2011. A human monoclonal antibody, Benlysta targets specific immune cells, blocking biological activity that contributes to the production of autoantibodies.

Most people with lupus can lead normal, high-quality lives, despite their symptoms and the potential side
effects of treatment. Sitting down with your rheumatologist and discussing the different options and
what best suits your disease process is the key to therapy and management.

It is crucial to learn how to recognize the warning signs of a flare and how to take steps to ward it off or reduce its intensity. It is also important for people with lupus to receive regular health care, rather than seeking help only when symptoms worsen. Staying healthy requires extra effort and care for people with lupus, so it becomes especially important to develop strategies for maintaining wellness