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

Week: 522.5 Guest: Michell Petrie, M.D. Topic: Lupus and African Americans Host: Steve Girard Producer: Ed Graham

NEMA: We've talked recently with Dr. Michelle Petrie, an associate professor of Medicine and Director of Lupus Center at Johns Hopkins Hospital. Lupus is an auto-immune disease that forces the bodies defense mechanisms to attack itself, causing serious problems in many organs and joints. About 90% of Lupus victims are women, and its hormonally driven....the main treatments center around calming the immune system, and reducing inflammation and pain. Dr. Petrie, I want to talk today about the predisposition of African Americans to some difficult aspects of Lupus....

Petrie: Our African American patients with lupus are more likely to get kidney involvement. Kidney involvement can be quite serious in that if the inflammation is not treated early, and effectively, the patient may end up with renal failure, kidney failure, requiring dialysis, or sometimes transplant. Even with dialysis or transplant, patients with kidney failure have increased mortality. So, kidney failure from lupus is still one of the major causes of death in people with lupus.

NEMA: And another condition that affects blacks to a higher degree also complicates lupus...

Petrie: In addition, our Afro-American patients are more likely to have high blood pressure, hypertension...and the high blood pressure can further damage the kidneys. So, Afro- American patients really have sort of two reasons why they're going to have increased trouble with their kidneys. The first is that they're more likely to get the kidney inflammation from lupus in the first place, and the second is that the high blood pressure is going to worsen the damage the lupus causes.

NEMA: Is screening for lupus a possibility in the future?...

Petrie: Genetic predisposition is just a small part of the disease. So this is not like sickle cell anemia in African Americans, or cystic fibrosis in Caucasians, where is would make sense to screen, because then you could do family planning in high risk families. The genetic predisposition is so small, that of 100 children born to women with lupus, only two of those children will grow up themselves and get lupus. So screening for the genes that have been identified as predisposing genes is not going to be worthwhile.

NEMA: And, Dr. Petrie....along with more publicity for Lupus, what do you forecast for the future fight against the disease...?

Petrie: I think we're going to see a three pronged approach. The first is earlier diagnosis, earlier referral to specialists for appropriate treatment. The second prong is going to be clinical research, such as what I do, which is to identify in advance those patients with lupus who are at high risk for later damage, so that we can target them for better interventions. And the third prong is going to be laboratory research, to find the major cause of lupus, what I call factor X'....but even if we can't find factor X' right away, to find better ways to control the immune system. We know so much about how the immune system causes inflammation, our problem is, we don't right now have safe ways to turn off that inflammation, and that would be one of the major advances in the coming years....allowing people with lupus to have their immune systems re-tuned! So that it will no longer attack themselves.

NEMA: Thanks Dr. Petrie....for more information...call the Lupus Foundation of America at 1-800-558-0121. I'm SG.