Lupus Deaths on the Rise

By: Rosalind Ramsey-Goldman, MD, DrPH
Lupus deaths in the United States have sharply risen in recent years, according to a recent report from the Centers for Disease Control and Prevention. The number of deaths linked to the autoimmune disease rose to 1,406 in 1998 from 879 in 1979. Most striking was the change in death rate among black women, which rose 70 percent in this time period. The death rate among white women showed only a small increase.
What is Lupus?

Lupus is a chronic, autoimmune, inflammatory disease that affects a number of the body's systems. It most commonly strikes women during their childbearing years, between the ages of fifteen and forty-five, and it affects ten times more women than men in this age group. However, younger and older individuals can develop lupus. In these less commonly affected age groups (children and individuals over forty-five), females are only twice as likely to be affected than men.

What Causes Lupus?

Although the cause of lupus is not known, there is a genetic predisposition to developing an autoimmune disease such as lupus. The disease can first become evident when it is triggered by something in the environment, such as an infection, medication, or sun exposure. But most of the time we cannot identify the specific trigger for an individual patient. Sex hormones may contribute to the onset of the disease.

An autoimmune system breakdown
The immune system is the body's normal defense system against foreign or non-self invaders, such as infections from the environment or tumors from within the body. A normal immune response includes making antibodies and causing inflammation in an effort to rid the body of the foreign intruder. For example, when you are first exposed to chicken pox, your immune system will produce antibodies or proteins to fight the infection. The chicken pox antibodies protect you against having the infection a second time when you are exposed to the virus again. The autoimmune responses in people with lupus are not regulated properly, and they produce antibodies and inflammatory responses that are mistakenly directed against their own tissues. This mixed up reaction can occur in any organ, so recognizing the range of problems seen in lupus patients can be difficult and confusing. It is best to work with a specialist who can de-code the disease symptoms.

Four Forms of Lupus

There are four different forms of lupus, and each affects the body differently.

Drug-induced lupus: The most common form of lupus in older individuals is induced by drug exposure. It usually causes only a brief illness if the offending medication is identified and discontinued.

Discoid lupus: The second form is called discoid lupus, and occurs only on the skin. It causes a rash that can lead to permanent scarring of the skin. When the rash is in the scalp, it can be associated with permanent hair loss.

Systemic lupus: The third type of lupus is the systemic form, which is the most serious form, as it can affect any organ in the body. The systemic form is almost always associated with antibodies that are detected in the blood, causing the immune system to go haywire.
An overlap syndrome: Systemic lupus can also be part of an overlap syndrome that includes problems from more than one type of rheumatic autoimmune disorder such as lupus and rheumatoid arthritis.

Diagnosing Lupus

It can be very difficult to recognize lupus. In fact, people often live for years with the disease before receiving a proper diagnosis, because the symptoms are not always initially associated with the disease. These symptoms can occur at different times or all at once.
In order to make a diagnosis, a rheumatologist must study a combination of clinical symptoms, physical examination results, and certain laboratory tests. Though the range of problems associated with lupus is very broad and each patient is different, there are a number of symptoms characteristic of lupus that a rheumatologist will be looking for.

They include:

Unexplained fever, weight loss, fatigue
Arthritis with swollen joints, stiffness, and pain in the joints
Rashes that may worsen with under one hour of sun exposure
Recurrent oral or nasal ulcers
Bleeding from the gums or a prolonged menstrual period
Red rash on the legs that looks like many little pinpricks
Swollen legs
Difficulty urinating or foamy urine

Chest pain, especially worse when taking a deep breath
Color changes in hands with exposure to cold
Muscle weakness
Blood clots, including stroke and heart attacks in those under the age of 45
Recurrent pregnancy loss
Seizures, hallucinations, difficulty with memory, and other neurological problems Treatment
It is important for patients and their families to be educated about the disease, and treatment should include both education and counseling. Certain lifestyle changes are critical in the lives of lupus patients, and they include: getting enough rest, getting daily exercise, smoking cessation, eating a balanced diet, using sun protection every day, and taking medication for current symptoms and prevention of new problems.

The prevention of lupus-related complications, either from lupus itself or its treatment is considered to be a standard part of therapy. For example, hypertension (high blood pressure), hyperlipidemia (high cholesterol), osteoporosis (thin bones), which are all potential complications of steroids like prednisone, should be treated accordingly. Lupus patients should remember to be diligent about other aspects of their health and have regular, yearly check ups with a primary care doctor, and these visits should include pap smears and breast examinations for women, prostate examinations for men, and an update of vaccination requirements for all lupus patients.