House Call: Systemic lupus hits mostly women
Lupus is one of many types of autoimmune diseases that cause your immune system to mistakenly attack healthy body tissue. About 1.5 million Americans have a form of lupus, with most – 70 percent – having systemic lupus. About 90 percent of those affected by this type of lupus are women.
Common symptoms of systemic lupus include joint pain, swelling, chest pain when inhaling deeply, fatigue, unexplained fever, hair loss, mouth sores, sensitivity to sunlight, skin rash (especially a “butterfly rash” that shows up as redness over the cheeks and bridge of the nose) and swollen lymph nodes. Less common types of lupus include cutaneous lupus (only affecting the skin) and drug-induced lupus (caused by high doses of certain medications). Unfortunately, we do not yet know what starts the immune reaction in lupus.
Cutaneous lupus may start as round red rashes on the scalp and face or skin lesions elsewhere on the body. Some people have both systemic and cutaneous lupus. Drug-induced lupus has symptoms similar to those of systemic lupus.
Lupus is sometimes difficult to diagnose. Symptoms can overlap with those of other diseases, may come on gradually and may come and go. Blood and urine tests and sometimes a skin biopsy are necessary to rule out other diseases and confirm a diagnosis of lupus.
Drug-induced lupus is the easiest to treat because symptoms usually resolve within six months of stopping the medication that caused it.
While there is no cure for systemic or cutaneous lupus, treatment can control symptoms, reduce inflammation, and minimize discomfort and organ damage. With good self-care and adherence to treatment plans, people with mild to moderate cases of lupus can have good long-term outcomes.
Treatment for systemic lupus varies depending on the type and severity of symptoms, and may change over time if you have a sudden worsening of symptoms, called a lupus flare.
Nonsteroidal anti-inflammatory drugs (over the counter or prescription) like aspirin, ibuprofen and naproxen may be used for pain, swelling and fever. A medication related to those used for treating malaria, called hydroxychloroquine, is often recommended. Corticosteroids like prednisone can reduce inflammation from lupus during a flare. Immune suppressing medications are used if other medications are not effective or if your body is being damaged by the disease.
All medications used to treat systemic lupus can have side effects. Discuss with your doctor what to watch for and be sure to report problems. A change in dosage or to a different medication may be required.
Cutaneous lupus may be treated with topical corticosteroids in the form of creams, ointments, gels, liquids, lotions, sprays or foams. Topical steroids have far fewer side effects than oral steroids. Topical immune system inhibitors, called calcineurin inhibitors, are also helpful for reducing cutaneous lupus symptoms.
No matter what kind of lupus you have, there are things you can do to help yourself stay healthy. First, protect yourself from the sun by using sunscreen and wearing broad brimmed hats and protective clothing to help prevent flares. Eat healthy foods, including fruits, vegetables and whole grains. Exercise in whatever way you find most comfortable. Get plenty of good sleep. Limit alcohol and caffeine. Do not smoke – it can worsen the disease and reduce the effectiveness of medications. When you have systemic lupus, it is also important to get all usual preventive care, make sure your immunizations are current and get screened periodically for osteoporosis as well as monitored for side effects from treatment medications.
You can learn more about lupus, read about lupus research, and find local resources and support for people with lupus at www.lupus.org.
Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.