Lupus, which is termed “systemic lupus erythematosus” medically or also “systemic lupus”, is a rheumatic illness that is relatively rare. It is one of the auto-immune diseases with antibodies against the body’s own cells. There are about 30 cases of lupus among 100,000 black people, particularly Afro-Americans. Lupus is about 3 to 4 fold more frequent among them when compared to whites. Women are affected 9-fold more frequently than men (Ref.1). It is a disease with many different manifestations. And it is related to other autoimmune diseases with which there is an overlap: rheumatoid arthritis, scleroderma, polymyositis, Sjögren’s syndrome and dermatomyositis.
In some patients it affects the skin more (lupus rash), in others the joints and in the more severe cases it is a systemic disease affecting several internal organs. Recent research has established that lupus is genetically determined through several loci. There is at least one locus that controls susceptibility to lupus. There is at least one other locus that controls suppression of lupus and if it is missing the carrier of this gene defect is much more susceptible to lupus (Ref. 3).
Lupus is a multifaceted disease that has some genetic predisposition that needs to be triggered. Diagnostic efforts need to rule out secondary lupus as a reaction to drugs and other rheumatological conditions (about 5 other possibilities) need to be ruled out. When the diagnosis is confirmed, treatment should be supervised by a rheumatologist to ensure that aggressive therapy is warranted. Sometimes watchful observation might be the wiser thing to do. Care has to be taken not to overuse corticosteroids or immunosuppressive agents as the course of most lupus cases is relatively benign compared to the potentially deadly side effects of some of the therapeutic modalities.
1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 15.
2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 50.
3. BP Tsao et al. Curr Rheumatol Rep 2001 Jun;3(3):183-190.
4. D Alarcon-Segovia Isr Med Assoc J 2001 Feb;3(2):127-130.
5. CC Mok Semin Arthritis Rheum 2001 Jun;30(6):426-435.
6. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
7. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
8. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier