EZDOCTOR: Lupus Q & A with Rheumatologist: Dr. Santiago

Dr. Santiago-Casas joined Drs. Kahn and Riskin’s practice (South Florida Rheumatologist) after serving as an attending physician and Associate Professor of Medicine in the Department of Rheumatology at the University of Puerto Rico Medical Sciences Campus in San Juan, Puerto Rico.

You can book an appointment with Dr. Santiago-Casas in Hollywood, Florida here: 

What is systemic lupus erythematosus or lupus? 

This is an autoimmune disease where the body’s immune system that normally works to fight infections and harmful cells fails and attacks the body. It is 10 times more frequent in women and usually affects 20-30 year old women.  Lupus is most common in certain ethnic groups including African Americans, Asians and Hispanics. It is a chronic disease that can affect multiple organs in the body including the skin, joints, kidneys, lungs, and brain.  

What is the cause of lupus?

The exact cause of SLE is not known. However, both genetic and environmental factors have been linked to its development.

What are the symptoms of lupus? 

Lupus is a disease that affects multiple systems in the body. The symptoms of lupus include the following: tiredness or fatigue, weight loss, fever without cause, headaches, skin rash especially with sun exposure (this includes the characteristic rash that may appear on the nose and cheeks shaped like a butterfly), hair loss, mouth sores, easy bruising, joint pain, swelling, and/or stiffness, foamy urine, difficulty concentrating, and mood changes.  The spectrum of manifestations of SLE is wide, meaning that some people may present mild symptoms, while others present severe manifestations. The symptoms of arthritis occur in many lupus patients, commonly affecting the fingers, wrists and knees. The majority of the patients have periods of time where the disease is active (commonly known as flares), followed by inactive disease.  

How is SLE diagnosed?

SLE is diagnosed by evaluating the signs and symptoms the patient presents, as well as by the findings in physical examination. Certain laboratory tests are crucial for confirming a diagnosis of lupus. The most important screening test measures ANA, but having a positive ANA does not necessarily mean that a patient has lupus. If the patient presents a positive ANA, more specific tests are necessary to confirm the diagnosis.

What is the treatment of SLE?

There is no cure for SLE. However, there is very good therapy to control the disease and limit the damage to the organs. This therapy has particularly advanced over the lasts years.  The specific type of therapy depends on the manifestations and the severity of lupus. Milder symptoms may respond to non-steroidal anti-inflammatory agents (NSAIDs). Therapy also involves hydroxychloroquine and steroids which are used to control the immune system and prevent damage related to the disease. Steroids are very useful in lupus however their use should be carefully monitor as to prevent unwanted side effects such as weight gain, weakening of the bones, and diabetes, among others.  

-Other medications that suppress the immune system might be necessary to control lupus activity including mycophenolate, cyclophosphamide, and azathioprine. Newer medications that have been used to treat lupus patients include biologic agents such as rituximab, abatacept and recently belimumab, which has been FDA approved for treating SLE. 

-Avoiding the sun exposure is very important since it has been linked to flares of SLE. It is especially important to avoid exposure between 10 AM and 3 PM. Patients are advised to use protective clothing and sunscreen with SPF of 50 or greater. 

-It is recommended that lupus patients follow a well-balanced diet which is low in fat and high in fruits, vegetables and whole grains.  Since steroid use (prednisone) may be required, weight gain might be a possible side effect of therapy. It is important for patients to remain active.  Especially in patients who take steroids, calcium and vitamin d supplementation is advised. Calcium is recommended at a range of 1000-1200 mg daily, while vitamin d is recommended at 400-800 units daily, in order to decrease bone loss (which can occur with steroid use).

-A number of medications have been linked to worsening of lupus symptoms. It is crucial that patients tell their doctors they have lupus and the medications they are taking. 

Lupus and pregnancy

It is important that patients with lupus plan their pregnancies and discuss their desires of pregnancy with their doctors early in this process. The chances of having a pregnancy without complications improve when patients become pregnant once their lupus is in control. If the lupus is active, patients should avoid pregnancy due to the high risk of possible complications.

Lupus is a complex disease, many times very challenging to manage. Thus, it is crucial to follow with a Rheumatologist who is the expert in diagnosing and treating autoimmune diseases such as SLE in order to start therapy promptly and effectively.
This is the butterfly or malar rash, a red rash that involves the cheeks and nose and that is frequently triggered by sun exposure.
Lupus is a disease that can affect multiple organs. It can cause inflammation in the kidneys, the tissue lining the lungs (pleura) and heart (pericardium), and the brain.

Be sure to visit her website: http://www.southfloridarheumatology.com/

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