What should people with lupus know about lupus diagnosis?
By Dr. Robert Katz, Chair Lupus Society of Illinois Board of Directors and Medical Advisory Board
A diagnosis of lupus can be difficult due to the gradual development of symptoms. Suspected cases must be confirmed by a series of blood tests such as anti-double-stranded DNA antibodies and anti-Smith antibodies. Levels of certain complement proteins, which are part of the immune system, are measured and help to track the disease. Low complements tend to suggest the presence of lupus and increased lupus disease activity. Doctors sometimes use the 1997 American College of Rheumatology criteria for the classification of systemic lupus erythematosus to aid in the diagnosis.
There is no cure for lupus, and its management can be challenging, but new treatments have arrived that can be quite helpful. The immune system normally protects the body by producing antibodies that attack germs, cancer, etc., but with lupus the immune system misfires and instead produces “autoantibodies” that can attack the patient’s own tissues. This can lead to inflammation. The autoimmune antibodies can end up in immune cells in organs where they can cause tissue damage. Lupus is a chronic inflammatory disease that can affect the skin, the joints, kidneys, lungs, nervous system, and other organs of the body. Skin rashes and arthritis are particularly common. Improvements in therapy have significantly increased the patient’s quality of life and their life expectancy.
Early and aggressive treatment can prevent kidney disease from progressing to renal failure requiring dialysis. Most people with lupus can lead normal lives, but the disorder must be carefully monitored, and treatment adjusted as necessary to prevent serious complications.
There is a class of drugs which inhibit a certain type of white blood cell called B-lymphocytes. Two medications that inhibit B lymphocytes, rituximab (Rituxan) and belimumab (Benlysta), can be effective in treating systemic lupus. Rituxan is given every six months and Benlysta is given either monthly through intravenous infusion in a medical office or infusion center or as a weekly subcutaneous (under the skin) self-injection.
Benlysta is a human antibody called a monoclonal antibody that binds to the white blood cell B-lymphocytes and especially the B-lymphocyte stimulator protein (BLyS). The goal is to quiet lupus disease activity and prevent organ damage.
A new lupus medication anifrolumab (Saphnelo) as well as Benlysta and Rituxan are helpful in reducing disease activity and controlling flares. They allow lupus patients to taper their corticosteroid use.