By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

MODERN LUPUS THERAPY MEANS NORMAL LIFESPAN FOR MOST SUFFERERS

Question: My doctor thinks I might have lupus because of a chronic rash I have on my face. She called it a butterfly rash across my nose and cheeks. She wants to do several lab tests and says she will know something in a week or so. No one in my family has ever had anything like this. Can you tell me more about lupus and what else might cause this rash?

Answer: Lupus is ten times more common in women than in men. It is also more common in Native Americans, African Americans, Hispanic Americans and Asian Americans. This disease starts in the young adult years, with the onset usually before age 60.

There are two major types of lupus -- cutaneous lupus and systemic lupus erythematosus (SLE). Cutaneous lupus affects only the skin. SLE, on the other hand, can involve many different organ systems. The butterfly rash that your doctor described, can be a presenting symptom of both cutaneous lupus and SLE. Some patients with lupus also have a coin-shaped or oval-shaped rash on areas of the skin that are exposed to sunlight. This is called a discoid rash. There are other types, and subtypes, of lupus, including a very rare one induced by certain medications.

Cutaneous lupus is usually less serious and more easily treated than SLE. However, in about 10 percent of the cases, people with cutaneous lupus eventually develop full-blown SLE. At this time, there is no way to predict who will experience this progression and who will not.

Lupus is classified as an autoimmune disorder without a known cause. While the immune system is supposed to protect the body from foreign invaders like bacteria and viruses, in certain diseases the body is unable to tell the difference between its own tissues and foreign tissues. In these conditions, unfortunately, the body makes antibodies against itself. Lupus is a prime example of this type of disorder. It is a chronic autoimmune disease that can cause the body’s defense mechanisms to attack its own organs. In the cutaneous form, this is confined to the skin, but in SLE, many organ systems may be attacked -- including heart, lungs blood, brain, joints and skin.

Lupus is commonly called “the great imitator” because its symptoms are non-specific, and it is easily confused with other illnesses. The most common symptoms are achy joints, swollen joints, fever and fatigue. Twenty-five percent of people with lupus never have the “classic” butterfly facial rash that you have. These symptoms are also known to come and go, so people often do not seek medical advice early in the illness.

Treatment for lupus depends on the type and the severity of the problem. Most people are managed with non-steroidal anti-inflammatory medication, but others need steroids and, sometimes, immunosuppressive medications. This illness is not contagious and currently is not believed to run in families.

The good news is that with close medical management and good treatment, most people with lupus can now expect to live a normal lifespan. In fact, less than 20 percent of lupus patients will die as a result of having this disease.

It sounds like your physician is doing a great job of investigating your rash. Be sure to follow her advice for medications and follow up evaluations. You can also find additional reliable information at the Lupus Foundation of America Web site: www.lupus.org.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.