The Many Faces Of Lupus
“Medical students are often told ‘Know lupus and you know medicine,'” says Dr. Daniel Wallace, rheumatologist, in his book The Lupus Book. “Understanding the immunology of lupus will help us better understand AIDS, infections in general, allergies and cancer,” Wallace says. Just like lupus, those diseases are immune-related disorders. The factors that cause lupus go to the core of how the immune system works and advances in understanding it often have a spillover effect to the insight into other disorders, the author says.
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While lupus affects up to 1.4 million people, according to the Department of Health and Human Services (DHHS), a number of polls show that public awareness of the disease is poor.
Lupus is an auto-immune disease in which the body’s immune system mistakenly starts attacking its own tissues and organs. It’s a chronic inflammatory condition that can affect one or more organs, including the skin, blood, joints, heart, lungs and kidneys.
There are four different types of lupus but the most common type is systemic lupus erythematosus (SLE) which can affect different systems in the body and whose severity ranges from mild to life threatening. Most often a mention of simply “lupus” refers to this type of the disease since about 70 percent of lupus cases are systemic. In about half of the systemic cases, a major organ will be affected.
Nobody knows what exactly triggers lupus, but researchers believe it’s a combination of genetic and environmental factors. Ninety percent of lupus cases are among women. Lupus is three times more common in African-American than in white women and also more common in Hispanic, Asian, and American Indian women. African-American and Hispanic women develop symptoms at an earlier age than other women and African-American women have more severe involvement of internal organs, especially the kidneys, according to the DHHS.
Lupus and Infections
Infections are a common problem for people with lupus and they tend to last longer and require extended treatment, compared to people who don’t have lupus. People with lupus may be more likely to get infections, says Dr. John Davis Jr., rheumatologist and director of the Lupus Clinic at University of California, San Francisco. “They [patients with lupus] are more at risk because they have abnormalities in their immune system and most importantly take medications that suppresses the immune system,” Davis says.
A way to safeguard against infections is to work closely with a rheumatologist and report immediately any fevers, Davis says. Wallace recommends in his book that people with lupus exercise common sense and try to minimize their risk factors for catching an infection.
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Lupus and the Kidneys
Kidney disease is one of the most common complications of lupus, especially among African-American women. “Between 40 and 70 percent of people with lupus will have some form of kidney involvement and it can range from very mild to severe,” Davis says. Davis says some warning signs of kidney problems in people with lupus are swelling of the legs, frequent urination, especially at night, and high blood pressure. Many people with lupus, however, don’t show symptoms even when they have failing kidneys, so Davis recommends routinely testing blood and urine to catch kidney involvement in the earliest stages.
Lupus and the Heart
Two main types of heart conditions develop as a result of living with lupus. One is inflammation of the sack surrounding the heart and another is coronary artery disease which is narrowing of the small blood vessels that supply oxygen and blood to the heart.
Coronary artery disease is the leading cause of death in the United States for men and women, according to the National Institutes of Health. It’s also the third leading cause of death in people with lupus after complications of kidney disease and infection, according to Wallace. The difference between coronary artery disease in people with lupus and those without lupus is that those who live with lupus develop the heart condition earlier in life.
One way for people living with lupus to take care of their heart is to check their cholesterol regularly, says Davis, especially if the lupus has already affected their kidneys because then they’re more likely to have high cholesterol. “Keep your blood pressure under control, watch your weight, lower your cholesterol and exercise,” says Davis about heart disease prevention for people with lupus. “It’s the same prevention that you’d do for heart disease in people without lupus but you do it at an younger age and have a lower threshold for evaluating possible heart problems.”
Reading about lupus and the complications it can bring may sound disheartening to people living with the disease and others who are just finding out about it. There is good news though and that is that most people with lupus have only a mild form of lupus with no life-threatening consequences or major organ complications, Davis says. For those with severe lupus, research offers encouragement. “The good news about severe lupus is that many drugs are currently under investigation and they may be safer and more targeted to specific causes of lupus,” Davis says.