Get Into the Loop – Learn About Lupus Irene Blanco, MD, MS October 28, 2010 Cherkasky Auditorium, Montefiore Medical Center

Agenda Introduction to Lupus Lupus and Your Heart Dr. Mario Garcia Question & Answer Session

What is Lupus? Autoimmune disease: Excessive immune system activation Loss of tolerance of immune system to one’s body Certain genes are more likely to occur in patients with lupus Many of these genes encode components of the immune system. Abnormal estrogen metabolism In animal studies estrogen worsens disease activity and causes early mortality

Who Gets Lupus? Female:Male ratio of 9:1 during childbearing years Closer to 2:1 during childhood and after menopause, suggesting hormonal influence Disease in males is can be more severe 70% of SLE: females between ages 15-45 10% present age >60

Who Gets Lupus? Highest occurrence is in Afro-Caribbean females 1:250 African American to Caucasian ratio 3:1 Child of SLE mother - risk of SLE 1:15 (7%) 10-15% of SLE patients have 1st degree relative with SLE

Mortality 90% survive 5 years, 80% 10 years Renal disease causes worse prognosis African Americans have more aggressive and treatment resistant disease Two different causes of death: Early: disease activity and infections Late: cardiovascular disease, disease activity, end stage renal disease, and thromboembolic

Criteria for the Diagnosis of SLE Malar (Butterfly) Rash Lupus kidney disease Discoid Rash Neurologic Disorders: Sensitivity rash to the sun (Photosensitivity) Stroke, inflammation, depression, memory dysfunction, etc… Anemia, low platelets and low white blood cell count Ulcers in the nose and mouth Arthritis Abnormal blood antibody levels Fluid around the heart, lungs and in the abdomen ANA blood test

Malar (Butterfly) Rash Fixed red, flat or raised, over the bridge of the nose and cheeks Tends to spare the nasolabial folds

Discoid Rash Red raised patches with scaling, skin follicle plugging Can be very scarring Singer Seal afflicted with discoid lupus at age 23

Photosensitivity Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation

Oral and Nasal Ulcers Oral or nasopharyngeal ulcers, usually painless

Hair Thinning

Arthritis Non-erosive arthritis involving two or more joints, characterized by pain, swelling, or fluid collections 80% of patients have it Can move deformed fingers back into position Pain may be out of proportion with appearance

Severe or Life Threatening Complications

Preventative Treatment Treatment of SLE Active Treatment Preventative Treatment Topical Steroids Sunscreen NSAIDs At least SPF 30 Advil, Mobic, Naproxen Calcium, Vitamin D, Folate supplements Antimalarials To help prevent SE from other medications Plaquenil Influenza Vaccine Steroids Pneumococcal Vaccine Prednisone, Medrol Cytotoxics/Biologics Cellcept, Cytoxan, Imuran, Benlysta

Side Effects to Lupus Medications Weight gain Hair loss, or new hair growth in unwanted places Damage to the bones Osteoporosis and Osteonecrosis High blood pressure High cholesterol Low immune system and infections

Follow Up Visits How often depends on: Lupus activity, severity, response to treatment, type of treatment, need for monitoring of medication side effects At routine visits, blood and urine tests and should be checked Even in patients with previously normal values Patients with known kidney disease should also have urine checked every 8 weeks or so