Early detection, multiple meds best in managing elusive lupus symptoms

Published on Thursday, August 1, 2024

By: Danny Barrett Jr., dlbarrett@umc.edu

Lupus is often a master of mimicry among autoimmune diseases as it can damage the skin, joints, kidneys, brain and other organs.

When the immune system attacks those otherwise healthy tissues, specialists in the field of rheumatology are often playing a game of catch-up when prescribing proper treatment to control it and help patients regain quality of life.

“The majority of lupus patients have skin rashes and joint pain, but what concerns rheumatologists the most is when internal organs are affected because irreversible damage can occur,” said Dr. Cathy Lee Ching, one of two rheumatologists in the Division of Clinical Immunology. “Inflammation of the kidneys, or nephritis, occurs in 50 to 60 percent of lupus patients. It is very problematic because this is a silent disease. Patients don’t often know they have it unless it’s detected early. In advanced cases, patients develop leg swelling and may end up on dialysis and in need for a kidney transplant.”

Symptoms of it detected in the bloodstream and skin can even mimic diseases such as sickle cell or alopecia, in some cases. In the brain, it can present itself with seizures, which can be equally puzzling for both patients and health care providers.

“These symptoms are wide and diverse,” said Dr. Hanan Ibrahim, a rheumatologist who has diagnosed the disease in multiple places, even in blood cells. “The course of the disease is unpredictable, with patients having several periods of flare-ups with remissions in between.”

The fastest-acting medications tend to be forms of corticosteroids, which specialists say should be avoided for longer-term treatment of lupus in favor of a mix of immunosuppressants tailored to a patient’s individual needs and other factors, such as allergies.

“Those initial glucocorticoids are widely used by rheumatologists, primary care professionals and emergency medicine clinicians because they act fast to control symptoms and stop the inflammation,” Ching said. “However, these are not good medicines to take daily for years because they have a long list of potential side effects.”

Rather, specialists seek to find the correct mix of steroid-sparing meds such as the immunosuppressive pills hydroxychloroquine and azathioprine and injections or infusions of monoclonal antibodies such as belimumab or anifrolumab to help patients deal with the variable symptoms.

“Every patient should be treated in such a way, unless they have an absolute contraindication to it, or some form of allergy to it,” Ching said.

The most vigorous new research methods to find root causes of lupus, which affects about 1.5 million people in the United States alone, have included chimeric antigen receptor T cell, or CAR T, therapy, which was introduced this year at UMMC for cancer treatment. Other studies have focused on links between production levels of T cells and certain proteins that control the body’s reaction to environmental factors such as pollutants and bacteria.

Finding care at the right time to avoid the most devastating effects of the disease is crucial for those with either established or suspected lupus, said Dr. Gailen Marshall, director of the Division of Clinical Immunology.

“Lupus is a disease that can have terrible consequences for patients and their family,” Marshall said. “The best care comes from rheumatologists specially trained to care for patients with this illness. Mississippi has a shortage of trained rheumatologists who have available appointments, but UMMC rheumatologists are readily available to care for these patients who can receive an appointment in a matter of days.”

Anyone with established or suspected lupus should have their primary care provider send a referral to the rheumatology section in the Division of Clinical Immunology at 601-984-5540.

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