Don't Jump the Gun with Lupus

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Category: Systemic Lupus Erythematous Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD
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Lupus, the Latin word for wolf, is an autoimmune disease that causes inflammation in the joints, skin, kidney, lungs or brain. This disease got its name from its telltale rash on the cheeks and bridge of the nose making a wolf-like mask.

Amelia, a forty-year old accountant with generalized aching, fatigue, numbness and headaches tested positive for ANA (anti-nuclear antibody). Is it lupus? Mary, a thirty-year old secretary with a five years of fatigue, joint pain and swelling in her hands and wrists also had a facial rash, aggravated by sun exposure, protein in her urine, and a strong positive ANA. Is it lupus?

Diagnosing lupus is not an easy task. Commonly, many people are mistakenly diagnosed with lupus, like Amelia, because of a positive ANA and non-specific symptoms such as fatigue, generalized aching, or headaches. The truth is that ten million Americans have a positive ANA, but less than one million actually have lupus. ANA can be linked to other diseases and be present even in healthy people, particularly the elderly. And even though 95% of people with lupus have a positive ANA, relying solely on this test to make a diagnosis is unwise.  

ACR CRITERIA:

Because other connective tissue diseases such as rheumatoid arthritis, and other non-rheumatic diseases such as fibromyalgia and hypothyroidism can mimic lupus, the American College of Rheumatology (ACR), revised the diagnostic criteria for lupus in 1996. According to this revision, confirming a diagnosis of lupus requires the presence of four out of the eleven of the following symptoms as Mary has.

1. a butterfly or wolf-like rash on the cheeks and nose, 2. a discoid rash (thick, scarring, disk like rash, on sun-exposed areas), 3. sun sensitivity (rash after being exposed to ultraviolet light), 4. oral ulcerations (recurrent mouth or nose sores), 5. arthritis (inflammation of two joints with tenderness), 6. serositis (inflammation of the lining of the lung (pleura) or the heart (pericardium)), 7. kidney disorder (protein or abnormal sediment in the urine) or 8. neurological disorder (seizure or psychosis), 9. hematological disorder (hemolytic anemia, low white blood cell count, low platelet counts), 10. immunological disorder, anti-phospholipid antibodies, lupus anti-coagulant, anti-DS DNA, false-positive syphilis, positive anti-SM), 11. a positive ANA can be associated with lupus.

Non-steroidal anti-inflammatory drugs, hydroxychloroquine, corticosteroids and immunosuppressive drugs are the treatment of choice for lupus. And even though an early diagnosis is essential to begin treatment, jumping the gun is not the way to go. Because of potential drug toxicity, the disease’s psychological burden and the possibility of future insurance problems, it is crucial to make an accurate and definite diagnosis.

So, if you have a positive ANA with lupus-like symptoms, see your doctor if you experience fevers, weight loss, skin rashes, joint swelling or chest pain and keep one step ahead of lupus’ evolution.

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