Lupus (Systemic Lupus Erythematosus; SLE)

Lupus is an auto-immune disease that can affect many parts of the body.  Nobody knows the cause, which is likely a combination of genetics, unknown environmental factors, and hormones (since it’s much more common in women than in men).  In addition to general fatigue & achiness, some common symptoms include:

  • joint pains
  • rashes (especially one on both cheekbones & nose)
  • hair loss (in one or more patches, usually not all over)
  • finger pains in the cold (with fingers changing color) (called Raynaud’s)
  • mouth ulcers
  • swallowing difficulties
  • recurrent miscarriages

In many patients, the disease always remains mild.  But dangerous complications can occur in the kidneys, lungs, and heart.  If the brain is involved, there can be strokes, seizures, &/or psychosis.

Diagnosis is made by the blood test for Antinuclear Antibodies (ANA).ย  A negative ANA is excellent for ruling out Lupus.ย  A positive ANA is only significant if it’s high, usually over 1:320 (“one to three-twenty”).ย  Then other blood antibody tests are ordered, like “anti-dsDNA,” “anti-Smith,” and more.ย  Some are used to diagnose Lupus, others to rule out other similar diseases.ย  Other blood tests can be helpful, like “Complement” (immune system proteins), a complete blood count,ย  an ESR and/or CRP, and a urinalysis for protein (for kidney damage).

But lab tests can be misleading, with many false-positives.  If I suspect Lupus, I refer to a rheumatologist to confirm the diagnosis by reviewing both lab tests and especially symptoms.  X-rays don’t help.  The goal of treatment is partly to relieve symptoms, but mostly to prevent serious damage if it’s begun to appear.  Medications can work well, but each has its own risks and toxicities.  Many, called โ€œbiologics,โ€ are expensive (and are heavily advertised on TV, showing happy patients bouncing playfully in springtime, while a sing-song voice in the background quickly summarizes a long list of main dangers, some fatal).  I let rheumatologists prescribe them.

Lupus in pregnancy can be serious for both mother & especially the fetus.  Rheumatologists absolutely need to be involved in care from the beginning.  One of my patients with kidney involvement from Lupus was advised to terminate her pregnancy for her own protection, which she unhappily did.  Then she got her Lupus under control with medication, to conceive again safely (and now has a gorgeous little daughter).

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