Reports From National Arthritis Meeting

Dr. Shiel Gives Perspectives Of Interest On Systemic Lupus Erythematosus (Lupus) From 2001 Annual Scientific Meeting Of The American College Of Rheumatology

Introduction

Lupus is a chronic inflammatory condition that is caused by autoimmune disease. Autoimmune diseases are illnesses that occur when the body's tissues are attacked by its own immune system. The immune system is a complex organization within the body that is designed normally to fight infections and other foreign invaders. Patients with lupus have unusual antibodies in their blood that target their own body tissues. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous system. Generally, when only the skin is involved, the condition is called discoid lupus. When internal organs are involved, the condition is called systemic lupus erythematosus.

Below are perspectives on key reports presented at the recent national meeting of the American College of Rheumatology:

Estrogen Replacement Issues

Hormone (estrogen) replacement that is given to postmenopausal women did not increase disease activity. It did, however, increase clotting events.

Dr. Shiel's Perspective: The question as to whether or not estrogens given to lupus women could actually cause their lupus to worsen has been debated for some time now. This study showed that they did not exacerbate the lupus and were well tolerated. However, there was a slight increase risk of clotting events, such as phlebitis. I generally avoid estrogens, both in the form of hormone replacement and in the form of birth control, in lupus women who have antiphospholipid antibodies (such as cardiolipin antibodies) because of their association with clotting events.

Cancer Risks

Lupus patients are at an increased risk for developing cancer. The cancer risk is most dramatic for blood cancers, such as leukemia and lymphoma, but is also increased for breast cancer.

Dr. Shiel's Perspective: Doctors and lupus patients should be especially vigilant for cancer with periodic general re-examinations.

Cigarette Smoking

Lupus patients who smoke have increased measures of disease activity.

Dr. Shiel's Perspective: The lupus patients who currently were smoking were found to have increased activity of their disease than non-smokers or former smokers! Lupus patients have even more reason NOT to smoke.

Male vs. Female Lupus

Men with lupus had higher death rates and more tissue damage than women of the same age and duration of lupus.

Dr. Shiel's Perspective: This goes along with a longstanding belief that men with lupus, on the whole, can have worse outcomes. It does not apply in individual situations, but for the male group as a whole.

Disease Activity

Lupus patients with elevated levels of DNA antibody had an increased risk of relapse of their disease.



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