What Black Women Should Know about Lupus

Lupus is a serious health problem that affects mainly young women. Nine out of 10 people who have lupus are women. The disease often starts between the ages of 15 and 44. People of all races may get lupus, however, it is three times more common in black women than in white women. As many as 1 in 250 young black women will get the disease.

Lupus is a disease that can affect many parts of the body. It can affect the joints, the skin, the kidneys, the lungs, the heart, or the brain. Only a few of these parts of the body are affected in most people.

Something goes wrong with the body's immune system in lupus. As part of the body's immune system, we have many different types of antibodies that defend the body from attack by germs and viruses. In lupus, however, the immune system becomes overactive and goes out of control. The antibodies attack healthy tissues. This attack induces inflammation, causing redness, pain, and swelling in the affected parts of the body. This tendency for the immune system to become overactive may run in families.

Types of Lupus
There are three major types of lupus:

• Systemic lupus erythematosus, sometimes called SLE, is the most serious form of the disease. Systemic means that it may affect many parts of the body, such as the joints, skin, kidneys, lungs, heart, or the brain. This type of lupus can be mild or serious. If it is not treated, SLE can damage the internal organs.
• Discoid or cutaneous lupus mainly affects the skin. The person with discoid or cutaneous lupus may have a red rash or a color change of the skin on the face, scalp, or other parts of the body.
• Drug-induced lupus is caused by certain prescription medicines. The person with drug-induced lupus may have the same symptoms as the person with systemic lupus, but it is usually less serious. Usually when the medicine is stopped, the disease goes away. The most common drugs that can cause lupus are (1) procainamide used for heart problems, (2) hydralazine used for high blood pressure, and (3) dilantin used for seizures. Drug-induced lupus is usually found in older men and women of all races.

Signs of Lupus
The signs of lupus differ from one person to another. Many people with lupus look healthy. Some people have just a few signs of the disease; others have more. Lupus can be hard to diagnose and is often mistaken for other diseases. Common signs of lupus are:

• Red rash or color change on the face, often in the shape of a butterfly across the bridge of the nose and the cheeks
• Painful or swollen joints
• Unexplained fever
• Chest pain during breathing
• Unusual loss of hair
• Pale or purple fingers or toes from cold or stress
• Sensitivity to the sun
• Low blood count

These signs are more important when they occur together. Other signs of lupus can include mouth sores, unexplained "fits" or convulsions, hallucinations or depression, repeated miscarriages, and unexplained kidney problems.

Signs of lupus tend to come and go. There are times when the disease quiets down, or goes into remission. At other times, lupus flares up, or becomes active. Years ago many people with lupus died; now with good medical care most people with the disease can lead active, productive, and fulfilling lives.

Causes
We don't know what causes the immune system to become overactive. In some people, lupus becomes active after exposure to sunlight, infections, or certain medications. Lupus is not infectious and cannot be caught or spread to other people. Most relatives of lupus patients do not develop the disease, but in some families more than one member gets lupus.

We do not know why the disease is more common in black women. However, research doctors supported by the National Institutes of Health are studying this problem. Researchers are also studying what causes lupus to start, and why is it mild in some and severe in others. Other researchers are studying why the signs of lupus differ between black women and white women.

Treatment
If you think you have lupus, you should see a doctor or a nurse and be examined and tested for lupus. She or he will talk to you and take a history of your health problems. Many people have lupus for a long time before it is detected. It is important that you tell the doctor or nurse about all your symptoms.

The doctor may treat each lupus patient in a different way because the signs of lupus often differ from one person to another. The doctor may give aspirin or similar medicine to treat painful, swollen joints and fever. Creams may be prescribed for a rash, and stronger medicines prescribed for more serious problems.

At this point, lupus cannot be cured. However, in many cases, signs of the disease can be relieved. The good news is that with the correct medicine and by taking care of themselves, most lupus patients can hold a job, have children, and lead a full life.

Outlook
The outlook for lupus patients has greatly improved. Research doctors are studying many aspects of lupus, such as what goes wrong with the immune system, why the disease runs in families, how lupus causes damage in the body, and why it can lead to repeated miscarriages. Others are researching why lupus is so much more common in women, especially black women. Researchers have learned a great deal about lupus and are studying new ways to treat and, ultimately, prevent the disease.

This information is made available by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.