Disease can mimic other illnesses and conditions

May is Lupus Awareness Month. Awareness of this chronic disease lags, as 63% of American surveyed have never heard of lupus or know little about this disease.

Systemic Lupus Erythematosus, also known as lupus, is an inflammatory, multi-systemic, autoimmune disease with clinical manifestations that can change frequently and unexpectedly. Lupus can be mild, severe and anything in between. This disease can affect any part of the body from head to toe. Lupus is characterized by periods of flare and remission. If patients are not diagnosed and treated early, it can lead to irreversible organ damage.

Whom Does Lupus Affect?

There are 1.5 million Americans and at least five million people worldwide diagnosed with lupus. Most people develop the disease between the ages of 15-44. This condition usually presents in women of childbearing age, with nine out of 10 adults diagnosed with lupus being women. Fifteen percent of lupus patients are children, but men also have lupus.

Lupus is two to three times more prevalent among women of color, including African- Americans, Hispanics/Latinos, Asians and Native Americans and affects one in every 250 young African-American women in the United States. Contributing factors such as poor access to health care further compound the above statistics. African-American and Hispanic/ Latino women with lupus have mortality rates that are at least three times higher than Caucasian women.

Diagnosing Lupus

The cause of lupus is unknown. Scientists believe that hormones, genetics and environmental factors, including sun exposure and ultraviolet radiation damage, may play a role. A lupus diagnosis can take four or more years and often includes requesting second opinions from multiple health-care providers. The disease is a great masquerader, and initial symptoms can mimic viral illnesses or allergic conditions. Patients express symptoms such as fatigue, stiffness, low-grade fever, swollen lymph nodes and rashes. Lupus can affect the skin, causing photosensitivity, a butterfly rash on the nose and cheeks, scarring rashes with hair loss, mouth and nose ulcers. Anemia, low white cell count or low platelet count can also be seen in some lupus patients. Internal organs, including the kidneys, heart, brain or lungs, may be impacted by the illness.

Diagnosis of lupus can be challenging due to the diverse nature of its clinical features. The antinuclear antibody (ANA) blood test is positive in 95% of patients with lupus, with the concentration of antibodies seen in the ANA test being quite high. Diagnosis of lupus is not solely based on a single blood test and requires a constellation of symptoms with multiple positive autoantibodies.

Pregnancy and Lupus

Lupus tends to flare during pregnancy. The disease needs to be fully controlled for six months before pregnancy for the best outcome. Active lupus during pregnancy may cause preeclampsia, recurrent miscarriages, premature labor and even maternal death. A high-risk obstetrician and rheumatologist should closely monitor all pregnant lupus patients.

Lupus In Children

Pediatric lupus patients tend to express severe and aggressive disease. Roughly 50% of these patients have internal organ involvement, including kidney disease. Children with lupus are treated with non-steroid medications, as continuously high doses of steroid therapy could impair their growth and development.

Treatment Options

Lupus patients need to maintain a healthy lifestyle reflecting a well-balanced diet, calcium and vitamin D supplementation, physical therapy and exercise. Patients should also avoid sun exposure by wearing hats and using sunscreen with SPF 30 or above.

The treatment of lupus requires immunosuppressive medications. These medications suppress the overactive immune system to prevent ongoing inflammation and organ damage. In severe cases, the patient requires hospitalization to receive high-dose IV corticosteroids. Steroids are gradually tapered down. The patient should not remain on high-

dose oral steroids due to serious side effects such as high blood pressure, diabetes, heart disease, stroke, osteoporosis (weak bones), osteonecrosis (dead bone) or stomach ulcers. Patients with severe symptoms may require chemotherapy medications like Rituximab and Cyclophosphamide.

All lupus patients should be cared for by a multidisciplinary clinic with a rheumatologist and other specialists. The goal of the Center of Excellence for Arthritis and Rheumatology (CEAR) at LSU Health Shreveport is to provide comprehensive care to our adult and pediatric lupus patients. The center takes a multidisciplinary approach focusing on physical and psychological wellbeing.

Dr. Samina Hayat is the Robert E. Wolf Professor of Medicine and Rheumatology, chair of Rheumatology Department, and the director of the Center of Excellence for Arthritis and Rheumatology at LSU Health Shreveport.

Dr. Sarwat Umer is an associate professor and dually trained as an adult and pediatric rheumatologist at the Center for Excellence for Arthritis and Rheumatology at LSU Health Shreveport.