Lupus: Preventive Health Issues

Transcript:

Lupus: Preventive Health Issues

Transcript:

Guest:  Dr. Diane Kamen – Rheumatology and Immunology

Host:  Dr. Linda Austin – Psychiatry

Dr. 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?

Dr. 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.

Dr. Linda Austin:  Now, why would fractures and osteoporosis be a particular concern for lupus patients?

Dr. 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 Carolina.  But, 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.

Dr. 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?

Dr. Diane Kamen:  Absolutely.

Dr. Linda Austin:  So, then, in your research, what are you trying to do to prevent that?

Dr. 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.

Dr. Linda Austin:  So, are patients with lupus, then, particularly susceptible to heart disease?

Dr. 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 people.

Dr. Linda Austin:  So, what do you do to help these patients so that doesn’t happen?

Dr. 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.

Dr. 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?

Dr. 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 lupus.

Dr. Linda Austin:  Any other areas that you’re looking at, in particular, for preventive health?

Dr. 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 screening.

Dr. Linda Austin:  Is cancer more common in lupus patients?

Dr. 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.

Dr. Linda Austin:  And the screening methods that we do have?

Dr. Diane Kamen:  The screening methods seem to be good. 

Dr. Linda Austin:  Would you suggest that a lupus patient start with mammograms earlier than the common recommendations?

Dr. 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.

Dr. Linda Austin:  I see. 

Dr. 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.

Dr. Linda Austin:  So, it’s important for all of us to do these preventive health behaviors.

Dr. Diane Kamen:  Absolutely.

Dr. 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.

Dr. 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.

Dr. Linda Austin:  Dr. Kamen, thank you so much.

Dr. Diane Kamen:  Thank you.