Autoimmune disorders are insidious. The body’s own protective mechanism, the immune system, turns on itself, attacking healthy tissue and organs by mistake. Lupus is one autoimmune disease that affects an estimated 1.5 million Americans, according to the Lupus Foundation of America (LFA).
“Lupus is a classic autoimmune disease in that the person makes antibodies to their own cells and this causes an inflammatory process; and as a result, they present with multiple different symptoms,” says Dr. Terry Moore, director of rheumatology at Saint Louis University.
Symptoms vary, but among the more common are painful or swollen joints, fever, fatigue, and a rash across the nose and cheeks. “The textbook presentation of lupus is a woman in her 20s or 30s who develops a rash when exposed to the sun; and inflammation of multiple organ systems, including joints (arthritis), the lining of the heart and lungs, kidneys, lungs and eyes, as well as mouth sores, hair loss, and the destruction of red and white blood cells and platelets,” says Dr. Rand Sommer, a rheumatologist on staff at St. Luke’s Hospital. “There can be involvement of about every organ. The disease never follows a textbook course.”
It is not known why women are more likely to develop lupus, although hormonal or genetic aspects may be involved. Diagnosis is based on a careful history and review of symptoms, along with a battery of lab tests that help rule out other types of disorders. In many cases, a lupus diagnosis is made over time, known as ‘a diagnosis of exclusion’—the one disease left to explain the patient’s complaints.
Once diagnosed, physicians can begin developing a treatment plan, which is individualized to the patient. “Depending on which antibodies are present, you know which organ systems are involved,” explains Moore. “We usually do baseline studies on heart, lung and kidney to make sure everything there is stable.”
Moore adds that early diagnosis improves the prognosis. “Twenty years ago, your survival was about 45 percent; and today, we don’t talk about that. We talk about 20-year survivals of 90 to 95 percent because of early diagnosis and aggressive therapy.”
Anti-inflammatory and antimalarial drugs used for cancer and transplantation are used in accordance with the severity of the disease, Sommer explains. “Recently, new biological agents have been approved for a subset of lupus patients. The biologicals are synthesized antibodies that are infused or injected into the patient.”
Alternative and complementary medication that may be helpful in easing symptoms include flaxseed, fish oil, DHEA and vitamin D. Some evidence suggests that acupuncture may help control joint pain, and meditation or biofeedback are useful for stress management. However, the LFA states, “Although we remain hopeful that newer, more effective therapies will be developed, we must be cautious regarding products that have not been approved by the Food and Drug Administration.”
New treatments are being investigated, and Sommer is optimistic. “It’s an exciting time in rheumatology, especially in the field of novel therapeutics in lupus. With a better understanding of the mechanisms of autoimmunity, immune smart bombs, antibodies that interrupt the inflammatory and autoimmune destructive effects have been discovered.”
For instance, Sommer notes that in 2011, the drug Benlysta was approved for mild to moderate lupus, marking the first time in 56 years that a drug had been approved specifically for lupus. “Benlysta is like an immune smart bomb that interrupts the attack of lupus on different organ systems,” he says.
For those who have lupus and those yet to be diagnosed, new research and drug development offer hope. “The most important thing to understand about this disease is that therapeutics are in the midst of a revolution,” Sommer notes. “There is so much research occurring right now. There is so much hope.”