The very nature of lupus is known to baffle doctors and patients alike. First, the disease cannot be diagnosed until it affects several different organ systems. Trouble is, the disease usually comes on gradually, affecting just one system at first, such as the joints or skin.

Consequently, if the initial symptoms are joint pain and swelling, doctors may suspect arthritis; if they involve a skin rash, doctors may suspect psoriasis. It’s not until the disease progresses and involves several other systems that doctors can finally diagnose lupus. Other systems lupus is known to affect include the kidneys, blood, heart, nerves, brain and lungs.

An autoimmune disorder
“Lupus is a classic autoimmune disease,” explains Tawatchai (Kee) Paisansinsup, MD, a rheumatologist with Park Nicollet Clinic Rheumatology. “Usually, the autoimmune system fights infection, cancer, tumors and other debris. But with lupus, it malfunctions and attacks healthy tissues and organs.”

Systemic lupus, the most common form, can vary greatly from one person to another. At one end of the spectrum, symptoms can be severe and life threatening; at the other, they can be so mild they are hardly noticeable. At times, symptoms can flare up dramatically or subside entirely.

No single blood test
Another reason lupus is challenging to diagnose is it has no reliable test. Instead, doctors watch for certain clinical symptoms and consider a patient’s risk factors and family history. The following are some common symptoms:

• photo-sensitive skin rash
• swollen joints
• kidney inflammation
• anemia
• fluid around the lungs or heart (pleural/pericardial effusion)
• chest pain with breathing (pleurisy)
• low-grade fever and fatigue
• nerve disorders, such as convulsions or neuropathy

Although lupus can strike males and females of all ages and races, most people who contract the disease are:

• women of childbearing age
• African-Americans, Hispanics and Asians

If doctors suspect lupus based on a patient’s symptoms and risk factors, they perform a blood test (anti-nuclear antibody or ANA) that helps diagnose the condition. But, because many people will test positive but not actually have lupus, doctors perform additional tests to confirm the diagnosis.

Park Nicollet has teamed up with the University of Minnesota and the Mayo Clinic to recruit participants for a clinical study that is tracking people who have received a “false” positive test for lupus. “The goal of the study is to find molecular marker(s) that will help predict a small subset of people who eventually will develop lupus or other connective tissue diseases.” For more information or to participate, call the Rheumatology Resource Center at 952-993-2758.

Treatment options vary
People who have mild forms of lupus may only need sunscreen for sun sensitivity or ibuprofen to treat mild joint discomfort. For more serious symptoms, doctors prescribe anti-malaria drugs, corticosteroids, chemotherapy or immunosuppressive drugs. Medications often have to be adjusted, especially when symptoms fluctuate.

“In the past, lupus was generally treated with steroids and chemotherapy, which suppressed the entire immune system. To improve lupus treatment, scientists and doctors are working together to find new treatments that are more targeted and produce fewer side effects,” Dr. Paisansinsup says.

To find a doctor to help with lupus or other rheumatic illnesses, call 952-993-5500, or visit parknicollet.com/rheumatology.