a special program of the National Emergency Medicine Association (NEMA)
Week: 522.2 Guest: Michelle Petrie, M.D. Topic: Lupus...How Is It Treated? Host: Steve Girard Producer: Ed Graham
NEMA: Most people don't know much about Lupus. I didn't before I talked with Dr. Michelle Petrie, a Rheumatologist who runs the Lupus center at Johns Hopkins Hospital. For instance, the disease strikes more people than Multiple Sclerosis and Cerebral Palsy, can hit just about anywhere in the body because its an auto-immune disorder, and about 90% of its victims are women. Why, Dr. Petrie?
Petrie: Several female hormones probably cause the immune system to be more active. Back in evolution, it was probably a healthful thing for women to have more active immune systems, because it would help a woman to survive childbirth infections, for example. Nowadays, the fact that women have more active immune systems is more of a hindrance than a help...because nowadays we have antibiotics to treat most infections. In general, women are just more likely to get auto immune diseases, where the immune system begins to attack self, not just lupus...but auto-immune thyroid disease, such as Graves disease, which is what Mrs. Bush had. In terms of what hormones are really important in lupus patients? The estrogen hormone is important, but so are some other hormones...such as prolactin. Prolactin is the hormone that is able to induce lactation in women who want to nurse their babies, but in women with lupus, Prolactin may actually contribute to the activity of their disease.
NEMA: Since lupus causes many different types of problems throughout the body, how do you go about treating it?
Petrie: Treatment of lupus is very confusing, because we treat lupus in every organ system a little bit differently. So they're are probably no two lupus patients who are going to be treated in the same way. And that's one of the reasons why specialists, Rheumatologists, are very important in coordinating the care of someone who has lupus. But the basic tenet of treatment is to calm down the immune system. About 90% of women and men with lupus will require pregnazone, which is a cortical steroid hormone. The problem is that very high doses of pregnazone can have side effects in and of itself. Among the side effects of pregnazone are weight gain, diabetes, an increase in cholesterol, an increased susceptibility to infection...and osteoporosis. So for that reason, we try to combine other medications that can also help to suppress the immune system or can help to suppress inflammation.
NEMA: To show how baffling lupus is....I understand one of the mainstays in preventing the body's inner fight is an anti-malarial drug first found to help lupus affected soldiers in world war 2...40 years ago! Why does this drug help Lupus sufferers?
Petrie: We know that hydroxychloroquin affects the processing of proteins that are then recognized by the immune system as foreign...so it seems to be able to tell the immune system, "this is self, you should not attack this organ anymore, this is y'know, part of the person." But in terms of understanding all the mechanism of action, the answer is no. NEMA: Lupus can have a ravaging effect on its victims, one in every 400 women...one in every 250 African American women...a lot more than people think. For more information on lupus, call the Lupus Foundation of America at 1800 -558-0121. I'm SG.