DOCTOR'S VIEW ARCHIVE

Arthritis Conference Report 2003

William C. Shiel, Jr., MD, FACP, FACR, Editor of the  Focus On Arthritis Center, Gives Perspectives Of Interest On Systemic Lupus Erythematosus From 2003 Annual Scientific Meeting Of The American College Of Rheumatology. 

• Introduction
• Sleep Quality
• Plaquenil (hydroxychloroquine) & Prevention of Blood Clots
• Osteoporosis Prevention Available, Underused

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:

Sleep Quality

Researchers from Canada and England reported that poor sleep quality was a significant factor for fatigue in patients with systemic lupus erythematosus.

Dr. Shiel's Perspective: These reports emphasize the importance for patients and physicians to address sleep quality and the effect of underlying depression, lack of exercise, and self-care coping strategies on overall health.

Plaquenil (hydroxychloroquine) & Prevention of Blood Clots

Researchers from the  University of Texas and the University of Alabama-Birmingham found that Plaquenil (hydroxychloroquine) significantly decreased the frequency of abnormal blood clots in patients with systemic lupus. Moreover, the effect seemed independent of immune suppression, implying that Plaquenil can directly act to prevent the blood clots.

Dr. Shiel's Perspective: This fascinating work highlights an important reason for patients and doctors to consider Plaquenil, especially for those lupus patients who are at some risk for blood clots in veins and arteries, such as those with phospholipid antibodies (cardiolipin antibodies, lupus anticoagulant, and false positive VDRL). This means that not only does Plaquenil reduce the chance for reflares of lupus, but it can also be beneficial in 'thinning' the blood to prevent abnormal excessive blood clotting.

Osteoporosis Prevention Available, Underused

In a large study of patients seen in the setting of a rheumatic diseases division of a major university, one quarter of patients at risk for osteoporosis by taking cortisone medication for diseases such as rheumatoid arthritis and lupus were not receiving ANY form of prevention for osteoporosis.

Dr. Shiel's Perspective: The entire field of osteoporosis management has changed in recent years. Guidelines for the prevention of osteoporosis clearly emphasize that persons who are chronically taking cortisone medications should receive osteoporosis prevention counseling. This should include recommendations for diet, exercises, avoiding cigarette smoke, and when appropriate, estrogen replacement and/or medications to build bone density.

Patients with systemic lupus erythematosus were reported to be inadequately screened for osteoporosis.

Dr. Shiel's Perspective: An old rule of medicine that I teach students,. "If you don't take a temperature, you can't find a fever." We as healthcare givers must be more vigilant in identifying and treating this preventable illness.

For more information, please visit the Systemic Lupus Center.

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