Michael D. Lockshin, MD

Ask the Expert
Michael D. Lockshin

The biggest problem in answering this is the definition of ‘early’ and ‘late’ lupus. Some patients have very minor symptoms that persist for years and need almost no treatment; others are very sick from the outset of their very first symptoms.

Most people use the term ‘early’ to denote time, but in lupus the issue is probably one of severity. Clearly, the sooner the disease is recognized, and the sooner treatment is initiated, the less damage will occur. However, early treatment does not necessarily prevent later flares. Patients with SLE follow three types of courses: chronic active (accounting for about half of patient-years), relapsing-remitting, and long-remitting.

There’s also the concern about what sort of treatment is indicated. In some cases, that means corticosteroids; in others, immunosuppressives are needed, and in still others, anticoagulants. All have dangers associated with them, and it is a judgment call whether to use them or not in given circumstances. For example, even management of asymptomatic patients with anti-cardiolipin antibody is still controversial.

There is, in fact, so much variability in the treatment of an individual lupus patient that I cannot provide a clear answer about early or late treatment. However, I do not know of any research suggesting that early treatment prevents later serious flares. (For further treatment information, see Dr. Lockshin’s In-Depth Topic Review on SLE.)

See the complete article on the Hospital for Special Surgery’s web site

A Patient’s Reference
Michael D. Lockshin, MD

1. Definition
2. Pathogenesis
3. Clinical Presentation
4. Laboratory Findings
5. Differential Diagnosis
6. Initial Treatment
7. Long-term Management Issues
8. Prognosis
9. When to Seek Referral to a Specialist
10. Annotated Bibliography

1.  Definition
Lupus is an autoimmune illness in which parts of the immune system, which normally protect you from outside invaders, run amok and attack parts of your body.

Lupus has several forms:

* systemic lupus erythematosus (SLE), which can affect the skin and other organs throughout the body, including abnormalities in the blood;
* discoid lupus, which only affects the skin, causing a scarring rash (although subacute cutaneous lupus also primarily affects the skin);
* subacute cutaneous lupus is a form of systemic lupus in which a characteristic rash predominates, indicators in the blood are strongly positive, but involvement of other organs is usually mild;
* drug-induced lupus, which is relatively rare and disappears when the offending drug (such as hydralazine and procaine amide) is discontinued;
* neonatal lupus, which occurs in infants of women with specific blood test abnormalities.

(This article will focus primarily on SLE, with brief discussion of neonatal lupus in the section below on pregnancy.)

Although SLE is a chronic disease that usually lasts a lifetime, many patients have periods of flare (when symptoms worsen) and remission (when symptoms lessen or disappear).

SLE affects women nine times as often as men, blacks four times as often as whites, and is most likely to arise between the ages of 15 and 45. The reasons for this distribution are unknown.

SLE affects women nine times as often as men, blacks four times as often as whites, and is most likely to arise between the ages of 15 and 45. The reasons for this distribution are unknown.

Differential diagnosis and management of the various signs and symptoms differ depending on whether the patient is newly diagnosed and untreated or the patient has been treated for many years. (See Boumpas in bibliography below.) Two recent American textbooks for physicians present extensively referenced and detailed discussion of all aspects of these illnesses. (See Wallace and Lahita.) …

See the complete article on the Hospital for Special Surgery’s web site