Preventive Health Issues
Guest: Dr. Diane Kamen – Rheumatology and Immunology
Host: Dr. Linda Austin – Psychiatry
Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Diane Kamen, who is an
expert on the illness of lupus. Dr.
Kamen is a rheumatologist here at the Medical University of South
Carolina. Dr. Kamen, one of your areas
of great interest has been in preventive health issues for patients with
lupus. I know that there are several
different areas that you think about.
What are some of the most important concerns for these folks long term?
Diane Kamen: Now that we have these
newer treatments for lupus and people are going longer periods of time in
remission, we’re not seeing as many long-term complications of the kidney
disease and other complications of lupus that involve the skin or the
joints. Instead, we’re seeing things
that early prevention could really put a halt to, things like infections,
cancers and, something that I’m particularly interested in, fractures and
osteoporosis, and bone health issues as well.
Linda Austin: Now, why would fractures
and osteoporosis be a particular concern for lupus patients?
Diane Kamen: We used to think that it
was all of the prednisone and other forms of steroids that patients were given
as treatment. But, even in patients that
have not gotten high doses over long periods of time of these medicines, we’re
seeing, now, that the disease itself, the inflammation that goes on with lupus,
can impact the bone. And, something else
that’s important with that is vitamin D.
We’re seeing high rates of vitamin D deficiency in patients with lupus
and, really, in people in general. You
wouldn’t think that so much in South
now, with the use of sunblocks and sunscreens, and sun avoidance, and also
people with darker pigmented skin, you just don’t absorb and get that vitamin D
like we used to. So, we are starting to
see complications of vitamin D deficiency down the road, just one of which is
thinning of the bones in osteoporosis.
Linda Austin: So, in other words, the
lupus patients may have kind of a double whammy, the problems that the whole
population is having now, and then there may be an extra concern because of the
disease process itself?
Diane Kamen: Absolutely.
Linda Austin: So, then, in your
research, what are you trying to do to prevent that?
Diane Kamen: Well, first of all, just
education and awareness, because, with something like vitamin D, you can go and
get a supplement and take it, and that’s probably a better recommendation than
telling people to go out in the sun for 20 minutes a day without sunblock
on. So, you can replace your vitamin D
with over-the-counter supplement. Other
aspects of preventive care in lupus really takes a little bit more thinking,
like heart disease, it would take screening for cholesterol at a younger age
than, maybe, the primary care doctors are used to doing.
Linda Austin: So, are patients with
lupus, then, particularly susceptible to heart disease?
Diane Kamen: Yes. We do see
complications like strokes, heart attacks, heart failure in these young
patients with lupus, even controlling for some of the other known risk factors. We know lupus patients have more of a
predisposition for high blood pressure.
They tend to have higher cholesterol and more diabetes. Some of that might be from prednisone or
other medications. But, even removing
those things, we still see these things happening with heart attacks and
strokes in these young lupus patients that can be devastating. So, it’s not just the risk factors that you
normally think about, there’s something about the lupus itself, with
inflammation, that is hastening these diseases that we normally see in older
Linda Austin: So, what do you do to help
these patients so that doesn’t happen?
Diane Kamen: Well, certainly,
controlling the risk factors that we know about is huge, so, not smoking,
watching what you eat, avoiding the fried foods, exercising, controlling
diabetes if it’s present. Those things
are still very important, but also controlling the disease and doing anything
you can to minimize the amount of disease activity that’s there. And, with some of the newer medications, we
can do that without all the long-term complications of the steroids.
Linda Austin: So, are you more likely,
then, to do tests earlier, like getting a calcium score, for example, on a
lupus patient than a non-lupus patient?
Diane Kamen: Those questions are being
looked at in the research setting.
There’s a study ongoing here, at MUSC, looking to see what kind of
testing and what sort of pattern of progression we see with atherosclerosis in
patients with lupus. I don’t think we
know the right answer. But, certainly,
the things we do know, like the cholesterol screening and blood pressure
control, the things that have been proven to lower rates of cardiovascular
disease, need to be aggressively pursued in someone with the diagnosis of
Linda Austin: Any other areas that
you’re looking at, in particular, for preventive health?
Diane Kamen: Other things that seem like
common sense but, I think, just can’t be stressed enough are keeping up to date
with immunizations. With lupus, you’re
at a higher risk of developing an infection, even if you’re not on the
immune-suppressing medications. And, it
is the most common cause of death now that we’re not seeing as much kidney
disease and brain involvement leading to death.
Now that we have better treatments for those, we’re starting to see more
people come into the hospital with infections.
So, anything that can be done to prevent those would be very helpful,
and then cancer screening, staying up to date with age-appropriate cancer
Linda Austin: Is cancer more common in
Diane Kamen: Some forms of cancer, like
lymphomas. There have been some studies
showing female cancers at a higher rate, like breast cancer and uterine
cancer. But, there hasn’t been a good
connection that’s been discovered yet.
We don’t know if it’s the disease or the treatments. When the medications are looked at by
themselves, they don’t seem to increase the rates of cancer. So, we’re normally pretty comfortable using
the treatments that we do have available.
Linda Austin: And the screening methods
that we do have?
Diane Kamen: The screening methods seem
to be good.
Linda Austin: Would you suggest that a
lupus patient start with mammograms earlier than the common recommendations?
Diane Kamen: If there’s a family history
of breast cancer. Other than that, just
having lupus is usually not a reason to start earlier screening.
Linda Austin: I see.
Diane Kamen: The recommendations that
exist for the population, as a whole, seem to be very good at picking up
cancers in lupus patients as well.
Linda Austin: So, it’s important for all
of us to do these preventive health behaviors.
Diane Kamen: Absolutely.
Linda Austin: But, especially important
for lupus patients. And, it would seem
to me, then, that to have a really good ongoing relationship with a physician
who cares about those issues is very important so that she can remind you to
stay on top of those tests and screenings, and health behaviors.
Diane Kamen: Absolutely. I think what happens a lot of times, which
shouldn’t happen, but does, is that you get so focused on the lupus that you
forget about all these other important aspects of health in general. So, making sure that, globally, the patient
is cared for is so important.
Linda Austin: Dr. Kamen, thank you so
Diane Kamen: Thank you.
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