Diagnosing and Treating Lupus

A few months ago, I wrote about the prevalence of autoimmune diseases in women. Lupus is one such disease that disproportionally affects women. In fact, 9 in 10 lupus patients are women, primarily affecting women in the reproductive years between 15 and 44. Lupus is a chronic disease and like other autoimmune diseases involves the body attacking various tissues and organs. As with many diseases, severity and symptoms vary from patient to patient. Some have mild disease and are treated conservatively, while others have severe cases that require aggressive medical interventions.

Generally there are four main types of lupus and each varies in degree and treatment modalities. Systemic lupus erythematosus or SLE is the most common and grave and usually involves multiple organ systems including joints, skin, and kidneys. SLE sufferers commonly complain of fatigue, painful and swollen joints, skin rashes, sun sensitivity, hair loss, and many times develop kidney disease., A less serious but equally frustrating type of lupus is cutaneous lupus erythematosus or CLE that significantly affects the skin with predominate symptoms including rashes, skin ulcers or lesions. CLE patients can have hypersensitivity to sun and may develop a discoid, or coin-shaped lesions on the face and scalp. As lesions scale over they can leave scarring and may cause hair loss on the scalp. Sometimes, cutaneous lupus erythematosus can be an early sign of the more serious systemic lupus erythematosus that can develop later.

A less common form of lupus is drug-induced lupus, which manifest systems of lupus such as muscle and joint pain and sometimes fever albeit less acute. Culprit medications include those prescribed to treat rheumatoid arthritis, hypertension, and seizure disorders. While the risk of developing drug-induced lupus is rare, thankfully stopping a culprit medication will usually end the symptoms.

Pregnant women with lupus generally have successful outcomes, and infants are not affected by the disease. However, in very rare cases, antibodies pass from the mother, and the infant can be born with neonatal lupus which manifest with skin rashes, low blood counts, and liver and heart problems. Infants born with neonatal lupus often have skin rashes and may have low blood cell count and sometimes liver and heart issues. Thankfully many of the symptoms resolve as the infant grows.

The various forms of lupus may be difficult to diagnose, as there is not just one symptom. Rather a cluster of symptoms may signal a lupus diagnosis. These symptoms include but are not limited to: skin rashes or lesions which can be exacerbated by sun exposure, hair loss, fatigue, fevers, muscle weakness and aches, joint stiffness, chest pain, breathing difficulties, blurry vision, headaches, dizziness, memory and concentration problems, swelling of feet and legs, weight changes, poor appetite, depression, or sadness. Individually, any of these symptoms can be indicative of myriad of common diseases or conditions but when you experience several of these together, it may signal to your healthcare provider to investigate the possibility of lupus.

Unfortunately, at this time there is not one particular test that can give patients and their healthcare providers a conclusive diagnosis. Rather it is a collection of tests including laboratory, imaging tests, and possibly biopsies that may help to narrow down a proper diagnosis. No one test will direct a diagnosis, but positive results on many can help to close in on a meaningful diagnosis and hopefully impactful treatments. Lab tests include a complete blood count to measure your white blood cells, red blood cell, and platelet counts. Lupus patients often have low hemoglobin that causes anemia. Additionally lupus sufferers may have low white blood or platelet counts.

Another important blood test is the erythrocyte sedimentation rate that measures the rate at which red blood cells settle. While this test can be an indicator of other conditions, such as infection or other inflammatory responses in the body, it can be a sign of lupus. A blood test designed to test for the presence of antibodies called antinuclear antibody or ANA test may be ordered to show if one has a stimulated immune system. Your healthcare provider will also want to order blood tests for kidney and liver functions that can be affected by lupus. Urine tests to check on kidney damage will also be ordered. If symptoms of lupus appear to affect heart or lungs, a provider may order a chest X-ray or echocardiogram to rule out any fluid or inflammation of these organs. Sometimes biopsies are required to diagnose and treat skin lesions or rashes. If your lab results indicate damage to the kidneys, a biopsy may be necessary to assess damage and best treatment options.

While the diagnosis of a chronic illness is never welcomed, many will be relieved to finally get an answer to the mystery that they may have endured for months or for some even years. The tricky part of lupus is that symptoms are often irregular and inconsistent, and it may take time for the multiple symptoms to coalesce and point to a proper diagnosis and treatment options.

As symptoms of lupus vary from patient to patient so too do the methods of treatment. Many healthcare providers will treat specific symptoms as they arise or “flare.” Achiness, stiff joints, and pain may be treated with anti-inflammatory medications, such as overthe-counter options like Advil, Motrin, and other NSAIDs. If symptoms are more severe, lupus patients may be referred to specialists such as a rheumatologist, who specializes in diseases of the joints and muscles, or a nephrologist if your lupus is affecting the kidneys. These providers may recommend the use of steroids to help with the inflammatory nature of lupus. Some patients may be treated with antimalarial drugs that have been shown to reduce flares of the disease. Newer medications such as immunosuppressive agents or chemotherapy may be used in the most severe cases of lupus when organ damage is threatened. While these medications can have serious side effects, for some with acute lupus disease, the benefits may outweigh the risks.

Lupus affects around 1.5 million Americans, chiefly women in the prime of their lives. If you or someone you know is experiencing symptoms, see your healthcare provider to discuss diagnosis and treatment options. 

Timothy J. Hardy, M.D.

Dr. Timothy Hardy, M.D. has been practicing medicine in the community for many years. He received his medical degree from Eastern Virginia Medical School and founded his own practice, Atlantic OB-GYN, in 1990, where he has been providing women with exceptional care ever since. Website: www.atlanticobgyn.com
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