Monday, May 20, 2013


Causes and treatments for lupus

Lupus is called a great imitator, because the symptoms can mimic multiple illnesses.

An autoimmune disease, the underlying mechanism of the disease is very complex. To complicate matters any organ in the body can be affected by lupus. 

Your immune system is your body's defense system. When healthy, it protects the body by making antibodies (blood proteins) that attack foreign germs and cancers. In lupus, the immune system misfires. Instead of producing protective antibodies, an autoimmune disease begins and makes "autoantibodies," which attack the patient's own tissues. As the attack goes on, other immune cells join the fight. These antibodies then end up in cells in organs, where they damage those tissues. We do not understand why this process begins. 

Lupus is predominantly a female disease. Women are affected 10 times as often as men. It is a chronic disease that can first present with joint pain and swelling. Over the course of time skin, kidney, heart and brain can be involved.  

At our Arthritis Center we provide care to multiple patients with lupus, ranging from 18-45 years old. The majority of patients are between 20 and 30 years old. The initial symptoms can be fever, joint aches, fatigue and just not feeling well. Skin rashes are common — they can vary from having a butterfly rash on the face, to a generalized rash throughout the body. The severity of the rash can sometimes coincide with the severity of disease. Sun exposure aggravates the disease.  Our patients can also develop mouth ulcers.

Some patients get really sick. They can have significant kidney involvement, ranging from mild protein in the urine to at times needing dialysis and kidney transplantation. Also lung involvement can range from pleuritis to significant fluid around the lungs. Heart involvement can range from fluid around the heart to involvement of the valves.

Once patients come with symptoms, and after clinical exam, we order a whole series of tests. The lab tests help us differentiate the cause and severity of the illness. We also do X-rays and sometimes echocardiograms. Some of our patients also need kidney biopsies.

The treatment is based on the severity of the underlying disease. Some patients may need prednisone for the management of their illness and others may need powerful chemotherapeutic agents. Recently a new medication was approved — Benlysta.

Given the chronic nature of the illness, we have to monitor our patients closely. They can have flare-ups and are at risk for  heart disease. To manage our patients we have to coordinate care with multiple specialists. Education and coordination of care can lead to better outcomes.

Sandeep Varma, MD, is the Medical Director of the Backus Hospital Arthritis Center. To comment on this column or others, visit the Healthy Living blog at or e-mail Dr. Varma or any of the Healthy Living columnists at

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