Bonnie Lee Bermas, MD
Lupus is an autoimmune disease in which the body makes autoantibodies. And those antibodies contribute to inflammation that can cause tissue damage. It's a multisystem disease, so what I mean by that is it's a disease that affects many organ systems. So it can affect the skin. It can affect the joints, the heart, lungs, kidneys and central nervous system.
We don't really know what causes lupus. We do know that genes play some part, that there are probably many genes involved. But it's not just enough to have a certain set of genes. It's genes in combination with some other trigger. And that other trigger could be an infection, could be environmental agent, or could be something you eat. We just don't know.
Lupus is mainly a disorder of young women. So what I mean by that is nine times as many women as men will develop lupus. And it's a disease that pretty much starts in teens and peak– the peak incidence is in women in their 20s and 30s. It is more common in women of African American, Asian or Latino background. But having said all that, lupus is a disease that can occur throughout anyone's lifetime, can impact men, and any race or ethnicity can be affected as well. It's estimated in the United States that roughly half-a-million to about a million people are affected with lupus.
Because lupus is a multisystem disease, there are many different presentations of lupus and many different types of symptoms that patients can get. So for example, patients can get what we call constitutional symptoms, which means they'll feel ill, like they have the flu; they can have fevers; and they can have weight loss. We also see a variety of skin rashes in people with lupus. Some people may have chest pain and shortness of breath, and that can be due to lung involvement, or heart involvement. People can get high blood pressure and headaches and swollen legs if their kidneys are involved. And of course, they can get joint involvement as well with swollen joints. They can also have some cognitive impairment where they feel that their thinking isn't clear and that their brain is in a fog.
One of the things that's also tricky about lupus is, people can have very different disease courses. Fortunately, most people will do fine. They'll have a full life and they'll be able to do all of their activities. And in my practice, for example, I would say probably 80% of my patients fall in that category. They can lead a full life as long as they're monitored or on therapy.
For other patients, they can have significant disease and that can really impact not only the quality of their life, but can cause significant organ damage – say, to their kidneys or heart or lungs – in which they may be– it may even be life-threatening at times. Fortunately, that's very rare.
We don't have a cure for lupus. What we like to do is try and get the symptoms under control. And we use various types of medications to do that. On one hand, we like to control symptoms, such as skin disease and joint symptoms, with medications that may just be treating the symptoms such as joint pain. So for example, we may use things like non-steroidal medications or low doses of steroids.
We also like to keep patients on a medication, if we can, called hydroxychloroquine or chloroquine, which were originally developed to treat malaria, but seem to not only help some of the symptoms of lupus, but may ultimately prevent more significant damage over time.
For people who have more significant disease where they're starting to get into organ system damage, such as kidney disease, we may end up using immunosuppressive agents. So those are medications that will suppress the immune system to decrease the activity of the immune system, which will hopefully keep the symptoms in check and prevent damage.
What Brigham and Women's Hospital Lupus Center can offer patients is a comprehensive evaluation of the clinical symptoms that they're having. It's also the latest research and innovative care. And we can do it in a coordinated fashion.
First, we have a designated lupus clinic. So what that means is we have eight board-certified rheumatologists who have both a special interest in lupus and expertise in lupus. Not only that, we work very closely with physicians in other disciplines. So we have, in a sense, a virtual center. We have close relationships with designated clinicians in the kidney or nephrology department, in the neurology department, in the dermatology department, in the obstetrics department, and in the cardiology department; all of which we work with closely, we know very well. And they also have an expertise and interest in caring for people who have lupus.
We have a three-pronged research approach. So we have some basic science researchers who are really trying to get at the nuts and bolts of what's going on in the immune system with lupus, genetically, what's triggering lupus, and also what's going awry. We also have epidemiologists who are looking large populations of people who have lupus and people who don't have lupus, and trying to figure out what triggers it – what are the environmental triggers? What are the other things that are pushing people to go on to have lupus? And not only develop lupus, but what makes lupus worse.
And then the third way we're doing research is, we are a center for clinical trials so that new medications that are thought to be highly likely to be effective in lupus, we are a site for some of the latest and most up-to-date clinical trials.
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