THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 521.3 Guest: Michelle Petrie, M.D. Topic: What is Lupus? Host: Steve Girard Producer: Ed Graham

NEMA: Lupus...its a strange word...and it fits a strange, complicated disease that hits its victim in many ways...hits mainly women...and can be very difficult to treat. I'm with Dr. Michelle Petrie, an associate professor of medicine at Johns Hopkins Hospital, and director of the Lupus center at Hopkins. Dr. Petrie, what is Lupus?

Petrie: Lupus is an example of the immune system making a really terrible mistake. The immune system is supposed to fight off infections, viral and bacterial infections, but in a person with lupus...the immune system starts to attack a perfectly normal organ, especially the skin, the joints and the kidneys.

NEMA: Why does it make our body attack its own cells?

Petrie: The quickest answer is to say that lupus is multi-factorial. Several different factors contribute to a person's risk of getting lupus. So, for example, their is a small, genetic predisposition in that certain genes that control the immune system may be more susceptible to lupus. There are some racial predisposition's, in that African Americans, probably Hispanics, and probably Asians are more likely to get lupus than Caucasians. And there are some environmental factors such as sunlight, ultraviolet light that may help to induce lupus. And basically lupus is a hormonally driven disease because 90% of patients with lupus are female. But the major cause, the one I like to call factor X', has never been discovered.

NEMA: Give me an example of the types of problems Lupus can cause?

Petrie: It's very confusing to try to diagnose lupus, because usually some very, nonspecific things will happen early, such as fatigue, which will be very difficult for a doctor to clue into...but eventually, lupus will occur in enough different organ systems, that the doctor will become suspicious and look for it and diagnose it, using helpful laboratory tests. It can cause a lot of different kinds of skin rashes, especially those that get worse in the sun. It can cause hair loss, sores in the mouth, it can affect the blood count, so it can cause anemia's...low white blood count. It can cause bleeding because the platelet count can be low, it can cause kidney inflammation and even kidney failure. It can cause water to accumulate around the heart and in the lungs. And it can also affect the brain, causing things such as seizures, or psychosis, when people have unusual or sometimes violent thoughts.

NEMA: How many people are affected by Lupus?

Petrie: Lupus doesn't get its fair share of press or national recognition because people think its such a rare disease....but in fact, lupus is more common than Multiple Sclerosis or Muscular Dystrophy,yet lupus doesn't have a telethon. So, one out of 400 Caucasian women get lupus, and one out of 250 African American woman.

NEMA: Lupus is treated, according to Dr. Petrie, by addressing the quieting of the body's auto immune system, and by attempting to calm the inflammation caused the invasion of Lupus. We'll find out more about it's treatment and its predisposition for women and minorities in future Heart of the Matter programs. If you would like to know more about the disease, call the Lupus Foundation of America at 1-800-558-0121