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Medical Edge Newspaper Column from Mayo Clinic

FINDING THE RIGHT TREATMENT FOR LUPUS TAKES TRIAL AND ERROR

DEAR MAYO CLINIC: My 38-year-old sister has had lupus for 10 years. It has left her virtually disabled. About a year ago, she had a heart attack, which required three stents to open her arteries. I would appreciate any information about this disease and treatment options.

ANSWER: Lupus is a chronic inflammatory disease affecting about 1.5 million Americans, mostly women. Symptoms include severe fatigue, body aches, unexplained fever and a butterfly-shaped rash across the face. People with lupus generally have episodes of symptoms called flares. Common triggers for flares are sunlight (ultraviolet light) and infection.

If lupus is not adequately controlled, chronic tissue inflammation can damage organs such as the kidneys, lungs, heart and central nervous system. Your sister’s heart disease is likely related to the lupus.

The exact cause of lupus is unknown. It appears to involve a combination of genes, environment and hormones. Here’s a simplified version of how lupus works its destruction:

Lupus is an autoimmune disease where the body’s immune system attacks its own tissues. It does this through the production of autoantibodies — that is, antibodies against the self.

Antibodies, which are proteins that protect health by attaching to bacteria or viruses, normally flag the invaders to be destroyed by immune-system cells. But for people with lupus, this flagging system goes awry. In simplest terms, healthy cells are flagged for destruction.

When immune cells attack healthy cells, they release chemicals that cause inflammation. Tissue damage results from persistent inflammation. In addition, there is a tendency for large concentrations of immune cells to clog small blood vessels.

There is no cure for lupus, but there are several types of treatments. Nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) and corticosteroids (e.g., prednisone) can ease the symptoms of inflammation. Antimalarial drugs also can help prevent inflammation and may reduce flares. Immunosuppressant medications work by blunting the immune system response. The particular combination of medications prescribed depends on the severity of disease and the level of organ damage.

Kidney transplantation is used for some patients who have severe kidney damage. Bone-marrow and stem-cell transplants are being used experimentally in some patients who haven’t responded to other treatments.

Finding the best treatment strategy is often a process of trial and error. Being aware of when symptoms are getting worse and knowing how to treat them can reduce the risk of permanent tissue or organ damage. While researchers seek more effective medications, it is important for each patient to work closely with an experienced specialist to quickly find the best therapy.

— Kevin Moder, M.D., Rheumatology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Rheumatology
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READERS: If you are overweight — and exercise regularly — are you healthy?
You may be relatively healthy at the moment, according to Mayo Clinic Women’s HealthSource. However, even if you exercise, being overweight is a risk factor for many health conditions. For example, being overweight puts you at a greater risk of developing diabetes. Regular exercise decreases this risk to some extent.

But even women at a healthy weight are at increased risk of certain diseases if they are inactive. One study in women reported that a lack of fitness was a more important predictor of dying than was excess weight.

Bottom line: Keep moving and work to maintain a healthy weight. Strive for at least 30 minutes of moderate-intensity activity, such as brisk walking, five or more days a week.
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.