Get Into the Loop – Learn About Lupus

Irene Blanco, MD, MSOctober 28, 2010Cherkasky Auditorium, Montefiore Medical Center

Agenda

• Introduction to Lupus

• Lupus and Your Heart

– Dr. Mario Garcia

• Question & Answer Session

What is Lupus?• Autoimmune disease:• Excessive immune system activation• Loss of tolerance of immune system to one’s body• Certain genes are more likely to occur in patients with lupus

• Many of these genes encode components of the immune system.

• Abnormal estrogen metabolism• In animal studies estrogen worsens disease activity and causes early

mortality

Who Gets Lupus?• Female:Male ratio of 9:1 during childbearing years

• Closer to 2:1 during childhood and after menopause, suggesting hormonal influence

• Disease in males is can be more severe

• 70% of SLE: females between ages 15-45• 10% present age >60

Who Gets Lupus?

• Highest occurrence is in Afro-Caribbean females 1:250

• African American to Caucasian ratio 3:1

• Child of SLE mother - risk of SLE 1:15 (7%)

• 10-15% of SLE patients have 1st degree relative with SLE

Mortality• 90% survive 5 years, 80% 10 years

• Renal disease causes worse prognosis

• African Americans have more aggressive and treatment resistant disease

• Two different causes of death:

– Early: disease activity and infections

– Late: cardiovascular disease, disease activity, end stage renal disease, and

thromboembolic

Criteria for the Diagnosis of SLE

Malar (Butterfly) Rash• Fixed red, flat or raised,

over the bridge of the nose and cheeks

• Tends to spare the nasolabial folds

Discoid Rash• Red raised patches with

scaling, skin follicle plugging

• Can be very scarring• Singer Seal afflicted with

discoid lupus at age 23

Photosensitivity• Skin rash as a result of unusual

reaction to sunlight, by patient history or physician observation

Oral and Nasal Ulcers• Oral or nasopharyngeal

ulcers, usually painless

Hair Thinning

Arthritis• Non-erosive arthritis involving

two or more joints, characterized by pain, swelling, or fluid collections

• 80% of patients have it• Can move deformed fingers back

into position• Pain may be out of proportion

with appearance

Severe or Life Threatening Complications

Treatment of SLE

Side Effects to Lupus Medications• Weight gain• Hair loss, or new hair growth in unwanted places• Damage to the bones

• Osteoporosis and Osteonecrosis

• High blood pressure• High cholesterol• Low immune system and infections

Follow Up Visits• How often depends on:

– Lupus activity, severity, response to treatment, type of treatment, need for monitoring of medication side effects

• At routine visits, blood and urine tests and should be checked• Even in patients with previously normal values

• Patients with known kidney disease should also have urine checked every 8 weeks or so