William C. Shiel, Jr., MD, FACP, FACR, Editor of the Arthritis Overview, Gives Perspectives Of Interest On Systemic Lupus Erythematosus From 2004 Annual Scientific Meeting Of The American College Of Rheumatology.
- Introduction
- Blood Vessel Risks Highlighted
- Plaquenil (hydroxychloroquine) & Pregnancy
- Cellcept
- Birth Control Pills
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:
Blood Vessel Risks Highlighted
There were numerous reports that found a direct association between systemic lupus erythematosus and blood vessel disease, including atherosclerosis as well as carotid and coronary artery disease, including calcification of the coronary arteries. Also, the presence of antiphospholipid antibodies (such as cardiolipin antibody and lupus anticoagulant) were associated with an increased risk for atherosclerosis of blood vessels.
Dr. Shiel's Perspective: This was very big at this meeting. Patients with lupus are at an increased risk for developing heart disease and heart attacks. It is very important for patients with lupus to optimize their heart disease risk factors. This includes stopping cigarette smoking, controlling blood pressure, exercising regularly, weight reduction when necessary, and having evaluation of cholesterol profile, homocysteine levels, and blood sugar testing.
Plaquenil (hydroxychloroquine) & Pregnancy
Researchers from Johns Hopkins in Baltimore reported that Plaquenil can be safe for pregnant women with lupus.
Dr. Shiel's Perspective: Rheumatologists have been using Plaquenil during pregnancy to sustain remission in patients with lupus for some time now because previous work suggested its safety. In this study, Plaquenil did not impact the rate of live births or preterm births. The author of the study, Dr. Michelle Petri, a world's expert in lupus recommends continuing Plaquenil therapy throughout pregnancy to improve control of lupus activity.
Cellcept (mycophenolate) was shown in separate studies to be effective in treating both lupus kidney disease (membranous form of glomerulonephritis) and the signs of lupus inflammation in body areas other than the kidneys, including the joints and lungs.
Dr. Shiel's Perspective: We still need more weapons in the fight against this disease. It seems that in certain selected patients, probably those with more resistant disease, this treatment can be an option.
A landmark paper was presented that clearly shows that oral contraceptives do NOT increase the rate of flares of systemic lupus erythematosus.
Dr. Shiel's Perspective: This important finding is opposite to what has been thought for years. Now we can reassure women with lupus that if they take birth control pills, they are not increasing their risk for lupus flares. NOTE: Birth control pills or any estrogen medications still should be avoided by women who are at increased risk of blood clotting, such as lupus women who have phospholipid antibodies (including cardiolipin antibody or lupus anticoagulant).
For more information, please visit the Systemic Lupus Index.
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