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Could I Have Lupus?

With a wide range of symptoms that are often non-specific, lupus can be difficult to diagnose.

Lupus is an autoimmune disease that is most prevalent in women between the ages of 15 and 40. It can affect various parts of the body — your skin, joints, heart, lungs, blood, kidneys and brain. For many women, lupus can be a manageable disease with relatively mild symptoms. For others, it may cause serious and even life-threatening problems.

“Lupus is quite prevalent in African American women. We have a large number of lupus patients here in Detroit,” said J. Patricia Dhar, M.D., a rheumatologist with DMC Women’s Health Services, and principal investigator of the Wayne State University Lupus database.

One of the challenges in diagnosing lupus is the fact that the disease can present in so many different ways. “Many of the symptoms are non-specific and patients don’t necessarily look like they are sick,” said Dr. Dhar. “Sometimes patients have a rash or start to lose their hair, but many times, they just don’t feel well or they may feel achy. And who doesn’t feel that way sometimes?”


A range of symptoms may be seen in patients with lupus, including:
*Source: Office on Women's Health (OWH) in the U.S. Department of Health and Human Services (HHS) 

 
  • Fever
  • Prolonged fatigue
  • Loss of appetite
  • Changes in weight
  • Skin rashes
  • Hair loss
  • Sensitivity to sunlight
    • Seizures
    • Chest pain
    • Painful or swollen joints
    • Muscle pain
    • Mouth or nose ulcers
    • Anemia
    • Kidney problems


    Types of Lupus
    There are several different types of lupus, including:

    There are several different types of lupus, including:
    • Discoid Lupus which is confined to the skin. It is characterized by persistent flushing of the cheeks or disk-like lesions or rash that appear on the face, neck, scalp and other areas exposed to ultraviolet light. The rash is usually raised, scaly red but not itchy. These lesions, if not adequately treated, may develop into permanent scars. If they involve the scalp, they can result in bald spots.
    • Systemic Lupus Erythematosus (SLE) is usually more severe than discoid lupus and can affect almost any organ in the body. In some individuals, this may mean skin and joint involvement, while in others the lungs, heart, kidneys and blood may be affected. The disease is characterized by periods in which few if any symptoms are evident (remission) and other periods in which it becomes active again (flare). Periods of improvement may last weeks, months, or even years. The disease tends to remit over time. Some patients never develop severe complications, and the outlook is improving for those patients who do develop severe manifestations.
    • Drug-Induced Lupus is the result of certain prescribed drugs. These medications can create a lupus-like syndrome which is similar to SLE, but very rarely affects either the kidneys or the nervous system. The most commonly implicated drugs, are hydralazine (used to treat hypertension) and procainamide (used to treat irregular heart rhythms). Drug-induced lupus is more common in men than women because they are treated with these drugs more often than women. However, only about four percent of the individuals who take these drugs will develop the antibodies of lupus and an even smaller percentage will actually develop drug-induced lupus. When the medication is stopped, lupus symptoms usually fade.
    • Neonatal Lupus is a rare autoimmune disorder that is present at birth and affects infants of women who have lupus and/or Anti-Ro/SSA Antibodies. Affected infants often develop a red rash, may develop liver problems and low blood platelets. Some infants also develop a heart condition known as congenital heart block. The symptoms associated with neonatal lupus, with the exception of congenital heart block, usually resolve themselves within the first several months of life.

    Diagnosing Lupus
    The onset of lupus may be acute, resembling an infectious process, or it may be a progression of vague symptoms over several years. As a result, diagnosing the disease is often a challenge. A consistent, thorough medical examination by a doctor familiar with lupus is essential to an accurate diagnosis. This must include a complete medical history and physical examination, laboratory tests, and a period of observation. The doctor assessing a patient for lupus must keep an open mind about the varied and seemingly unrelated symptoms that the patient may describe.

    “When we see a patient, the first thing we do is to see what organs are involved,” Dr. Dhar said. “We do a lot of testing in the beginning. They get echocardiograms, pulmonary function tests and a lot of blood work. This is one of the ways we stage the disease.”

    No single laboratory test can definitely prove or disprove systemic lupus. Lupus is usually easy to diagnose when the individual has many of the more characteristic symptoms and signs, but is made more difficult if none or only a few are present. Laboratory tests are usually conducted to help confirm or reject the diagnosis. These tests may include a blood count (CBC), looking for low number of white blood cells, red blood cells, and/or platelets. The urine is examined for protein and red/white blood cells. Blood tests may be done to measure kidney function. A variety of laboratory tests, X rays, and other diagnostic tools are used to rule out other pathologic conditions and to determine the involvement of specific organs.

    Fortunately, specialists with DMC Women’s Health Services have extensive experience diagnosing and treating lupus.
    Source: Lupus Alliance of America, National Institute of Health

     


    Facts About Lupus

     

    • African-American, Latino, Asian and Native American women have a greater risk of developing lupus than white women, as high as three times more frequently. Although socio-economic factors may play some part, researchers believe that genetics for lupus in these racial groups is a more important factor.
    • Systemic lupus (SLE) appears in the first-degree relatives of lupus patients more often than it does in the general population, which indicates a strong hereditary component. However, most cases of SLE occur sporadically, indicating that both genetic and environmental factors play a role in the development of the disease.
    • 2 million people in the United States suffer from systemic lupus (SLE).
    • 16,000 Americans are diagnosed with lupus each year.
    • More people have lupus than cerebral palsy, multiple sclerosis, sickle-cell anemia and cystic fibrosis combined.
    • Young women are most frequently affected, out-numbering male patients ten to one. The onset of lupus occurs most often in persons 20-40 years of age, but can occur at any time.
    • Lupus is a complex disease whose cause is unknown. It is very likely that there is no single cause but rather a combination of genetic, environmental and possibly hormonal factors that occur together to cause the disease. The exact cause may differ from one person to another.

    Source: Lupus Alliance of America, National Institute of Health



     
    J. Patricia Dhar, MD

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

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