Lupus
Nancy Liu, MD, rheumatologist at UMass Memorial Medical Center and clinical associate professor of medicine at University of Massachusetts Chan Medical School. Dr. Liu also directs the UMass Chan Medical School Rheumatology Fellowship Program, training tomorrow’s rheumatologists. Board certified in internal medicine and rheumatology, Dr. Liu received her medical degree from Case Western Reserve University School of Medicine in Cleveland, Ohio, and served her residency at Tufts Medical Center, where she also completed a fellowship in rheumatology.
Dr. Liu sees patients with lupus, a chronic autoimmune disease that can affect many parts of the body (skin, joints, and/or organs inside the body). However, many patients with lupus may experience only some of the possible complications. Patients often experience periods of activity of their lupus and then improve with time and/or specific therapy. This disease affects as many as 1.5 million Americans, mostly women age 15 to 44, although men, children and teens can also develop lupus.
Physician
Nancy Liu, MD
Q:
What are the most common signs of lupus and how is it diagnosed?
A:
The most common symptoms of lupus are joint pain, skin rash (which can include unusual reaction to the sun), severe fatigue, chest pain with deep breathing (called pleurisy pain). There are several other symptoms described on the Lupus Foundation web site.
However, sometimes patients will present with more serious involvement such as kidney, blood, lung, or nervous system disease. Although the common symptoms often are nonspecific and can apply to many diseases, the diagnosis is based on the patients' symptoms along with the physical examination by a physician and laboratory testing. Unfortunately, there is no one blood test that absolutely makes the diagnosis. Thus, the diagnosis is sometimes difficult to make in the beginning but usually, with time, lupus can be confirmed or excluded.
Q:
If you have cutaneous lupus, will that lead to the serious one?
A:
Cutaneous refers to the skin, and cutaneous lupus erythmatosus is a form of lupus involving rashes and lesions in the skin. “The serious one” you refer to is systemic lupus erythmatosus and is what most people mean when they say “lupus.” Having cutaneous lupus does not mean you will develop system lupus, or vice versa. There are many forms of cutaneous lupus and many variations in the kind of skin disease they cause, and they each carry a different risk for the patient developing systemic lupus. For example, with discoid lupus, the patient’s lifetime risk of developing systemic lupus is only 5-10%. Each patient is different. Some patients with system lupus do develop skin problems, as well.
Another good source for patient information on systemic lupus is the American College of Rheumatology website for patients.
Q:
What exactly does “borderline” lupus mean?
A:
The term “borderline” lupus can be confusing, and I myself don’t use it with patients. Some physicians may use it when their patients’ blood work or symptoms hint at lupus but there is not yet a conclusive diagnosis.
Q:
Is lupus more common in women than men and if so, why?
A:
Yes, nine out of ten lupus patients are female, and there are likely hormonal contributions to the development of the disease. But men do get lupus as well and they can have the same symptoms.
Q:
What’s the latest treatment for lupus—anything new and promising?
A:
There are several new medications available for the treatment of lupus, in the areas of biologic agents. The most recently approved medication by the FDA is belimumab (Benlysta) for moderately severe lupus. Other medications that have not been approved but can be used include rituximab (Rituxan) and abatacept (Orencia).
Q:
Is there any way to predict “flares” of lupus symptoms? Are there common triggers to avoid?
A:
There is no way to predict the flares, but there are some common triggers discussed on the Lupus Foundation website. Some patients feel that learning their own likely triggers helps them avoid some flares.
Q:
I understand lupus can be caused by some medications. Which ones? (And is lupus then permanent, or does it go away when you stop taking those medications?)
A:
There are several medications that are well known to cause a drug-induced lupus syndrome. The most common include isoniazide, a medication for tuberculosis; procainamide for heart irregularities; and hydralazine for high blood pressure. There are other medications that are sometimes associated with lupus, but not as frequently. It is uncommon for drug induced lupus to persist beyond 4-6 months, once the offending medication is discontinued.
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