Speaking of Health – Lupus

By Gilda Morales, ANP, DC

Today’s column deals with another common disease, lupus.  It is a systemic disease that attacks Asians, Native Americans, and those of African descent three times more than whites and more than nine out of ten of those affected are women, usually of childbearing age.  Normally, the immune system protects the body from infection. In lupus, however, the immune system inappropriately attacks tissues in various parts of the body, leading to tissue damage and illness.

The symptoms of lupus differ from one person to another and the disease can affect any part of the body. Some of the more common symptoms include:

•Achy joints (arthralgia)

•Unexplained fever (more than 100 F)

•Swollen joints (arthritis)

•Prolonged or extreme fatigue

•Skin rash

•Ankle swelling and fluid accumulation

•Pain in the chest when breathing deeply (pleurisy)

•A butterfly-shaped rash across the cheeks and nose

•Hair loss

•Sensitivity to the sun and/or other light

•Seizures

•Mouth or nose sores

•Pale or purple fingers or toes from cold or stress (Raynaud’s phenomenon)

In addition to the symptoms above, lupus affects certain organs or body systems

in other ways.  Skin problems are a common feature of lupus with a familiar red rash over their cheeks and the bridge of their nose commonly called a “butterfly” or malar rash. Hair loss and mouth sores are also common with one particular type of lupus that generally affects only the skin is called “discoid lupus.” With this type of lupus, the skin problems consist of large red, circular rashes that may scar. Skin rashes are usually aggravated by sunlight and can range from mild irritation to serious blisters called a bullous lupus rash.

Arthritis symptoms are also very common in people with lupus, but fortunately, the arthritis usually is not crippling. Kidney involvement occurs in almost half the people with lupus and can be life threatening.  However kidney problems usually occur when other lupus symptoms are present such as fatigue, arthritis, rash, fever, and weight loss. Lupus may also cause dangerous reductions in the number of red blood cells, white blood cells, or platelets.  Although rare, there may be involvement of the brain and spinal cord, causing chest pain, fluid around the heart and difficulty breathing.

    Diagnosis of lupus is made through clinical presentation of at least 11 common signs and symptoms and a blood test called the antinuclear antibody test or ANA.  Treatment includes steroid creams applied directly to rashes or low doses of oral steroids for mild or moderate features of lupus. Steroids in higher doses are used when organs are being affected, but unfortunately, high doses also are most likely to produce side effects. Plaquenil, is commonly used to help mild lupus-related problems, such as skin and joint disease, with newer medications targeting the immune system and keeping the disease under control.