Get Into the Loop – Learn
About Lupus
Irene Blanco, MD, MS
October 28, 2010
Cherkasky Auditorium, Montefiore
Medical Center
Agenda
• Introduction to Lupus
• Lupus and Your Heart
– Dr. Mario Garcia
• Question & Answer Session
What is Lupus?
• Autoimmune disease:
• Excessive immune system activation
• Loss of tolerance of immune system to one’s body
• Certain genes are more likely to occur in patients with lupus
• Many of these genes encode components of the immune system.
• Abnormal estrogen metabolism
• In animal studies estrogen worsens disease activity and causes early
mortality
Who Gets Lupus?
• Female:Male ratio of 9:1 during childbearing years
•
Closer to 2:1 during childhood and after menopause,
suggesting hormonal influence
•
Disease in males is can be more severe
• 70% of SLE: females between ages 15-45
•
10% present age >60
Who Gets Lupus?
• Highest occurrence is in Afro-Caribbean females 1:250
• African American to Caucasian ratio 3:1
• Child of SLE mother - risk of SLE 1:15 (7%)
• 10-15% of SLE patients have 1st degree relative with SLE
Mortality
• 90% survive 5 years, 80% 10 years
• Renal disease causes worse prognosis
• African Americans have more aggressive and treatment resistant disease
• Two different causes of death:
– Early: disease activity and infections
– Late: cardiovascular disease, disease activity, end stage renal disease, and
thromboembolic
Criteria for the Diagnosis of SLE
• Malar (Butterfly) Rash
• Discoid Rash
• Sensitivity rash to the sun
(Photosensitivity)
• Ulcers in the nose and mouth
• Arthritis
• Fluid around the heart, lungs
and in the abdomen
• Lupus kidney disease
• Neurologic Disorders:
– Stroke, inflammation, depression,
memory dysfunction, etc…
• Anemia, low platelets and low
white blood cell count
• Abnormal blood antibody levels
• ANA blood test
Malar (Butterfly) Rash
• Fixed red, flat or raised,
over the bridge of the nose
and cheeks
• Tends to spare the
nasolabial folds
Discoid Rash
• Red raised patches with
scaling, skin follicle
plugging
• Can be very scarring
• Singer Seal afflicted with
discoid lupus at age 23
Photosensitivity
• Skin rash as a result of unusual
reaction to sunlight, by patient
history or physician
observation
Oral and Nasal Ulcers
• Oral or nasopharyngeal
ulcers, usually painless
Hair Thinning
Arthritis
• Non-erosive arthritis involving
two or more joints, characterized
by pain, swelling, or fluid
collections
• 80% of patients have it
• Can move deformed fingers back
into position
• Pain may be out of proportion
with appearance
Severe or Life Threatening Complications
Treatment of SLE
Active Treatment
•
•
Topical Steroids
NSAIDs
• Advil, Mobic, Naproxen
•
Steroids
• Prednisone, Medrol
•
•
Cytotoxics/Biologics
• Cellcept, Cytoxan, Imuran, Benlysta
Sunscreen
• At least SPF 30
•
Calcium, Vitamin D, Folate supplements
• To help prevent SE from other medications
Antimalarials
• Plaquenil
•
Preventative Treatment
•
•
Influenza Vaccine
Pneumococcal Vaccine
Side Effects to Lupus Medications
• Weight gain
• Hair loss, or new hair growth in unwanted places
• Damage to the bones
• Osteoporosis and Osteonecrosis
• High blood pressure
• High cholesterol
• Low immune system and infections
Follow Up Visits
• How often depends on:
– Lupus activity, severity, response to treatment, type of treatment, need
for monitoring of medication side effects
• At routine visits, blood and urine tests and should be checked
• Even in patients with previously normal values
• Patients with known kidney disease should also have urine
checked every 8 weeks or so