Lupus is a chronic inflammatory disease in which the body’s immune system attacks tissues and organs. It is called the “Great Imitator,” because it is easily confused with other conditions, including rheumatoid arthritis and chronic fatigue syndrome. While the disease can be fatal as well as deceptive, new treatments already approved by the FDA or in the approval pipeline have greatly increased patients’ chance of long-term survival and a relatively normal life.
We spoke to Dr. Alastair Kennedy, a Vero Beach rheumatologist, who has been treating lupus sufferers for decades. Speaking of the inflammation resulting from lupus, Dr. Kennedy says, “There’s not an organ system it can’t affect.” This includes joints, skin, kidneys, blood cells, and the brain, heart, and lungs.
When the immune system is healthy, it protects the body by making antibodies (blood proteins) that attack cancers and foreign germs. In lupus, the immune system misfires and produces autoantibodies, which attack healthy tissue.
Lupus is more common in African-Americans, Hispanics, and Asians than in Caucasians, and 90 percent of sufferers are women. According to Dr. Kennedy, there is no known factor that explains this, but there are metabolic differences between genders and between races which might play a role in the tendency to develop the disease. It is known that lupus has certain triggers – sunlight, infections, and some types of medication; specifically anti-seizure and blood pressure medicines and antibiotics.
Lupus is Latin for “wolf,” which refers to the facial rash many sufferers develop. In addition to being described as wolf-like, the rash has been likened to the wings of a butterfly unfolding across both cheeks.
No two cases of lupus are completely alike. Symptoms can develop slowly or come on suddenly. Some cases are severe, some mild. The condition can be temporary or permanent. Most people with lupus have a mild form, with “flares” – times when symptoms get worse for a period of time and then subside or go away altogether.
The signs and symptoms of lupus depend on which body systems are affected. In addition to the facial rash, the Mayo Clinic reports the most common signs and symptoms as:
• Fatigue and fever
• Joint pain, stiffness, and swelling
• Skin lesions that appear or worsen with skin exposure
• Fingers and toes that turn blue or white when exposed to cold or during stressful periods
• Shortness of breath
• Chest pain
• Dry eyes
• Headache, confusion, and memory loss
According to Dr. Kennedy, the diagnosis of lupus is not always easy and excluding other conditions is part of the process. There is no one test that can diagnose lupus; it’s detected through a combination of blood and urine tests, and a physical examination. A chest X-ray or echocardiogram is used if it’s suspected that the heart and lungs have been affected; if there is concern about kidney involvement, a biopsy may be done to see what damage has been caused.
There are 1.5 million people in the U.S. diagnosed with lupus; with 16,000 new cases each year; people are most commonly diagnosed between the ages of 15 and 40.
Lupus has traditionally been treated by medication, with several options available:
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as Aleve, Advil, and Motrin IB
• Anti-malarial drugs
• Corticosteroids, such as Prednisone
The severity of the condition determines the treatment. Immunosuppressants are sometimes used for more severe cases; Dr. Kennedy says, “These drugs have their own inherent risks, but may be appropriate if the brain, kidneys, or lungs are involved.”
Complications of lupus include kidney failure, anemia, pleurisy (inflammation of chest cavity lining), pneumonia, pericarditis (sac-like covering around the heart becomes inflamed), and infection. Dr. Kennedy says that there seems to be a slight increase in the incidence of lymphoma in lupus patients, particularly in more severe cases. A direct causality is hard to determine, however, because some of the drugs used to treat lupus can increase the chances of developing lymphoma.
As is the case with any chronic condition, it is important to see your doctor regularly (in this case, a rheumatologist), don’t smoke, eat a balanced diet, exercise, get plenty of rest, and take your medication as prescribed.
Advice specific to those with lupus: wear protective clothing and use a sunscreen with an SPF of 55 or higher for any outdoor activity, as ultraviolet light can trigger a flare.
According to Dr. Kennedy, the prognosis for lupus sufferers is much better now than it was several decades ago. “It used to be catastrophic diagnosis, with a 25 percent mortality rate within 5 years. It’s a whole new ballgame now, due to aggressive treatments.” With proper diagnosis, treatment, and lifestyle adjustments, upwards of 80 percent of people with lupus can expect to live normal lives, with a normal lifespan.
There is recent news from pharmaceutical giant AstraZeneca; in a clinical trial, an experimental drug significantly improved the symptoms of lupus. The drug targets interferon, a protein involved in inflammation. Further clinical trials and FDA approval are needed before this drug can become available to the public.
Dr. Kennedy spoke of biologics – medicinal products manufactured in or extracted from biological sources. A biologic, belimumab, was approved by the FDA in 2011; it is the first drug approved for the treatment of lupus in many decades. Dr. Kennedy is very optimistic about the future for those diagnosed with lupus; he believes “the next 50 years will be revolutionary.”
Dr. Kennedy’s office is located at 1330 36th St., #A1 in Vero Beach; his office phone is 772-569-8550.
