Lupus – Diagnosing Lupus

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Lupus:  Diagnosing Lupus




Guest:  Dr. Jim Oates – Rheumatology & Immunology

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Jim Oates, who is Associate Professor of Rheumatology at the Medical University of South Carolina.  Dr. Oates, I know one of your areas of deep interest and research is a very important, and all too common, illness, lupus.  Just what is lupus?  What are the symptoms of lupus?


Dr. Jim Oates:  Well, one thing that you have to keep in mind is that there are no two lupus patients that are alike.  But I can tell you a bit about what patients with lupus suffer from.  A majority of patients with lupus develop a rash, and often times it is a sun sensitive rash.  They often develop arthritis, which involves swelling and warmth of joints and, often, stiffness in the morning.  Most patients with lupus develop some sort of fatigue.  With that, alone, it’s very difficult to diagnose somebody with lupus, but when symptoms and signs of lupus begin to add on over time, the diagnosis is a little bit easier to make. 


People can have inflammation almost anywhere in the body.  So, you can have inflammation around the heart and lungs that result in prolonged chest pain, perhaps with pain upon taking a deep breath or lying down.  You can have inflammation in the kidney that can lead to kidney failure.  You can have inflammation in the brain that can lead from anything to very subtle deficits in memory, to seizures and strokes.  So, cells that carry oxygen, the red blood cells, can be affected, cells that are involved in clotting; the platelets can be affected, and cells that are involved in helping you fight infection; the white blood cells can be affected, and, usually, the numbers are low as a result of your body, essentially, attacking the blood cells.


Lupus is a disease where your immune system attacks the body.  And, what all lupus patients have in common is what we call autoantibodies.  These are proteins that we make to fight viruses.  We make these when we have a vaccine so that the next time we’re exposed to a particular virus, we’ll be ready to fight that infection.  And, lupus patients, their ability to differentiate things like viruses and bacteria from their own body is lost.  They begin to make these things, called antibodies, against their own body.  And it depends on what types of antibodies a patient has as to which organs are going to be involved. 


One thing that we do to make the diagnosis is ask about all the things that I mentioned, but also do blood tests.  There’s a blood test called an antinuclear antibody blood test that we do.  There is one difficulty with that test.  Five percent of the population is walking around with a positive test.  So, it’s not very specific.  But, when you couple it with these clinical symptoms and signs, it’s a lot easier to make the diagnosis.  So, a lot of what we do is differentiating between what we call a false positive, somebody walks in with a test that’s positive but without lupus, and people that really do have lupus.


Dr. Linda Austin:  Who is susceptible to lupus, younger people, older people, men, women?

Dr. Jim Oates:  It’s a disease primarily of women, and particularly of African-American women of their child-bearing potential.  So, it usually catches people during their child-bearing years.  Now, among African-American women, the epidemiological studies vary, but somewhere around 1 in 350 will have lupus.  It’s less than the general population, obviously.  So, the people that get it less are Caucasian men who are older.


Dr. Linda Austin:  I know there are some good treatments for lupus.  But, back in the days before there were any treatments for lupus, what was the natural course of this illness?


Dr. Jim Oates:  That’s a great question.  So, before steroids were offered, around 1950, late 1940s, if somebody had kidney disease or brain disease, it was fatal.  People who had rashes and arthritis suffered greatly, and often times they would progress to kidney disease in at least half the cases.  So, it wasn’t just a question of annoyance, there were fatalities from this.


Dr. Linda Austin:  Were there cases of spontaneous remission, where it would just go away by itself?


Dr. Jim Oates:  Patients that have drug-induced lupus might, or a lupus-like syndrome that comes with an infection may have a spontaneous remission, but true lupus, rarely remits spontaneously. 


Dr. Linda Austin:  So, without treatment, it would, just naturally, tend to progress?


Dr. Jim Oates:  Right.


Dr. Linda Austin:  Potentially, over many years or decades?


Dr. Jim Oates:  It could happen over that prolonged period of time, some patients, over the course of months.  It really depends on the individual and how aggressive their disease is.


Dr. Linda Austin:  Is it genetic?


Dr. Jim Oates:  There is a genetic predisposition.  That means, you can inherit genes that make you more susceptible to the disease, but twin studies have shown us that one identical twin can get lupus, while the other does not.  It’s about a 50/50 proposition in identical twins.  And, in a family, if you have a first degree relative with lupus, you have about a five percent chance of getting lupus.  So, there’s something besides your genes.  There is something in the environment, an infection.  There are studies showing that silica exposure with farming might have something to do with it.  There is no one gene, though, that we found, that will cause lupus.  Most likely, it is multiple genes combined that result in a predisposition for lupus.


Dr. Linda Austin:  Now, you mentioned that the way to diagnose this is by doing a blood test, fairly simple blood test, I gather, and that, combined with the symptom picture and the history, really gives you a pretty good take on that.  Is that something that a family practice doctor can do, or do those patients always get sent to a rheumatologist?


Dr. Jim Oates:  Because lupus is such a complex disease, often times we will get referrals after the test has been done.  But, most of the time, folks who are developing significant involvement in the joints or the skin, or any other organ, will end up seeing a rheumatologist. 


Dr. Linda Austin:  I want to talk about the treatment of lupus, but let’s save that for another podcast.  Thank you very much, Dr. Oates.


Dr. Jim Oates:  Thank you.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.


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