The Body at War with Itself

by Molly M. Ginty

Carla Vargas wished it was food poisoning. In April 2006, she discovered that the nausea, vomiting, and fatigue she was suffering were not signs of an ordinary upset stomach, but the first signs of lupus, an autoimmune disorder in which the body’s defense system turns on itself and attacks healthy tissue.

"Lupus had targeted my kidneys, which were beginning to fail," says Vargas, a 24-year-old college administrator in Falls Church, Virginia. "My doctor sent me straight to the hospital, where I stayed for two weeks. For six months afterward, I had to take medications that caused hair loss, weight gain, and insomnia."

Despite these side effects — and despite knowing she has an incurable disease — Vargas counts herself lucky. "Lupus can be difficult to detect, and catching it early saved my life," she says. "I’m blessed that it’s only affected my kidneys and that the drugs I continue to take are keeping it under control."

An inflammatory disease that usually strikes the kidneys, joints, skin, blood cells, or heart, lupus can be difficult to diagnose—and so difficult to treat that the 1.5 million Americans who have it must remain ever vigilant. Since 90 percent of patients are women—and since the disease usually strikes them between the ages of 15 and 45 — health advocates are making a special effort in October, which is Lupus Awareness Month, to warn young women like Vargas about this chronic disease.

Menstruation. Pregnancy. Infections. Stress. And exposure to ultraviolet light. If you’re predisposed to lupus, any of these can trigger a flare-up, spurring your antibodies to attack your own cells and causing inflammation and pain in almost any part of the body.

Achy joints. Fever. Swelling. Fatigue. Reddened skin. Anemia. Kidney problems. And chest pain. These are the most common signs of lupus. Others include a butterfly-shaped rash across the nose, hair loss, seizures, mouth ulcers, clogged arteries, inflammation in the chest, and fingers that turn pale in the cold (Raynaud’s syndrome).

"These symptoms can appear one at a time, or all at once," says Dr. Gary Gilkerson, vice chair of medicine at the Medical University of South Carolina and a spokesperson for the Lupus Foundation of America. "They can be short term or lifelong, contained in one part of the body or systemic. Lupus symptoms can mimic signs of other illnesses. All of this makes the disease very difficult to diagnose, which is why it can take from one to three years — and three to four physicians — before you know you have it."

To help clinicians make definitive diagnoses, the American College of Rheumatology has compiled a list of 11 set symptoms that are hallmarks of lupus. The presence of at least four is considered proof of the disease. When people know that they have lupus, they can control flare-ups by shunning sunlight (which may trigger skin rashes), getting regular exercise (to fight fatigue), and breaking bad health habits such as smoking or drinking heavily (which can exacerbate symptoms).

They can load up on fish (rich in anti-inflammatory omega-3 fatty acids) while avoiding nightshade vegetables such as tomatoes and eggplants (which may trigger flare-ups). To compensate for the loss of sunlight, which the body needs to make vitamin D, they can take supplements to ensure that they get at least 800 IUs of vitamin D per day.

People with lupus should shun medications known to cause flare-ups, such as minocycline (an antibiotic), hydralazine (for high blood pressure) and procainamide (a heart medication). But they may need to take other drugs that combat lupus: immunosuppressants, non-steroidal anti-inflammatory drugs (NSAIDs), anti-malaria drugs (which ease skin, joint, and ulcer problems), and corticosteroids (to reduce inflammation).

Women need to take extra precautions. Birth control pills are not recommended for women with lupus, since they may already have blood-clotting problems, and IUDs carry an increased risk of infection. While it’s generally considered safe to get pregnant, symptoms can worsen around the fourth week of gestation. Lupus can cause antiphospholipid syndrome, which compromises blood clotting and can lead to miscarriage. Mothers with lupus can pass the condition on to their infants even if they have no symptoms themselves. And while women over 50 usually have milder flare-ups, hormone therapy to treat the symptoms of menopause can exacerbate these episodes.

While researchers work to improve treatments for lupus, they are also trying to find its cause. Only 10 percent of people with the disease have a close relative who is also affected, but lupus seems to have some genetic component: It is more common among African Americans, Hispanics, Asians, and Native Americans than among Whites. Last summer, scientists discovered a genetic defect that makes some mice susceptible to lupus. Other studies show that blocking the expression of certain genes can minimize symptoms. "In humans, there may be 50 to 60 genes involved in lupus," says Gilkeson. "When we find them, we will make great progress in fighting this difficult disease."

Molly M. Ginty lives in New York. Her work has appeared in Ms., Marie Claire, Redbook, and Women’s eNews.

For more information
Lupus Foundation of America www.lupus.org
American College of Rheumatology www.rheumatology.org

Article published in Lutheran Woman Today, October 2007