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Despite Advances,

Lupus Still a Formidable Foe

By Gardner

HealthDay Reporter

THURSDAY, May 13

(HealthDayNews) -- Deaths from lupus surged 44 percent in the United States

from 1998 to 2001, and hospitalizations soared 128 percent.

This followed a 60

percent to 70 percent jump in deaths from 1979 to 1989 due to the autoimmune

disease that has no cure, according to the U.S. Centers for Disease Control and

Prevention.

And while scientists

continue to make incremental strides against lupus, it remains one of the most

difficult diseases to diagnose and one for which there have been no new

treatment advances in more than 30 years.

Despite this grim

portrait, a conference held Wednesday at the 2004 International Congress on

Lupus in New York City

aimed to shed some hope on efforts to treat and manage the illness.

Lupus is an

autoimmune disease that primarily affects women between the ages of 15 and 44.

It causes the immune system to attack the body's own tissue and organs, including

the joints, kidneys, heart, lungs, brain, blood or skin. The disease may

eventually cause tissue damage, organ failures, disability and even death.

An estimated 1.5

million Americans have a form of the disease. Black women are three times more

likely to get the disease as white women; Hispanic and Asian women are also at

higher risk.

One of the primary

challenges of lupus diagnosis and treatment has been the lack of any

" biomarkers " -- or physical indicators -- to gauge who has the

disease and how it is progressing.

" There is an

urgent need for biomarkers, " said Dr. ph Ahearn, senior author of one

of the studies presented at the conference and co-director of the University of Pittsburgh's Lupus Center of Excellence.

" We need improved methods of diagnosing lupus so we can make sure that

when we are evaluating and treating patients we know this is lupus and not some

other disease. "

Symptoms of lupus can

mimic other illnesses, and range from mild to life-threatening. They include

achy joints; frequent fevers of more than 100 degrees F.; arthritis; prolonged

or extreme fatigue; and skin rashes. The disease can also enter periods where

symptoms aren't present, only to flare up unexpectedly, according to the Lupus

Foundation of America.

Doctors also need

blood tests so they can monitor the activity of the disease, Ahearn added.

" It would be nice to be able to monitor disease activity more accurately

and perhaps even predict upcoming flares, which would allow us to institute

therapy earlier, prevent hospitalizations and reduce the time of the

flare, " he said.

The right biomarkers

might also provide incentives to pharmaceutical companies to develop drugs to

treat lupus. As it stands now, drug manufacturers have no way of knowing

whether a particular drug is working, so they have been reluctant to

participate in clinical trials, Ahearn said.

Ahearn and his Pittsburgh colleagues

have determined that measuring fragments of two different proteins might

provide the right clues as to what the disease is doing to the body. After

looking at hundreds of patients, they discovered that the fragments attach to

red blood cells. " Not only are the fragments abnormally elevated on red

blood cells but the levels fluctuate as the level of activity of the disease

fluctuates, " Ahearn said.

The Pittsburgh researchers also found the

fragments on platelets, meaning they may be implicated in blood clotting.

" We think this is an extremely promising route to pursue, " said

Ahearn, who indicated that the team is working with the U.S. Food and Drug

Administration to bring this research to fruition.

Another study

presented Wednesday found the incidence of stroke and heart attacks were

elevated in women with lupus. Ethnicity, however, did not emerge as a separate

risk factor, said study co-author Dr. M.A. Toloza, of the University of Alabama

at Birmingham.

A third study found

that damage from lupus, rather than damage from the steroids that are used to

treat the disease, was likely responsible for low bone mineral density in women

with the disease.

" One of the

problems has been to separate how much of the low bone mineral density is

related to corticosteroids or to the disease itself, " said study co-author

Dr. Chin Lee, of Northwestern

University. " We were

able to show that the trend for lower bone mineral density seems to be

associated with disease damage independent of steroid exposure. " There may

be ways to start compensating for this damage as soon as a diagnosis is made,

the researchers said.

Finally, one study

examined part of lupus' social toll. Yelin, of the University

of California, San Francisco looked at almost 900 people

with lupus and found that while about 71 percent were working at the time of

their diagnosis, only 46 percent were still in the labor force 12 years later

-- a 48 percent drop. Among those who continued working, there were declines in

the number of hours worked per week and the number of weeks worked per year.

" Work disability

in lupus occurs much earlier in life and at much higher rates [than for other

diseases], " Yelin said. " If you get a disease like lupus, then you

leave work early in life and you also lose your long-term financial

stability. "

Also, because of the

severity of the disease (seizures were one of the main reasons cited for

inability to work), there were few opportunities to make accommodations in the

work environment sufficient to let people keep their jobs, Yelin said.

" At this point,

we do not have interventions in the disease process to change that

process, " Yelin said. " The work prognosis, in short, is quite poor in

relation to other diseases, including forms of cancer and rheumatoid

arthritis. "

SOURCES: May 12,

2004, news conference, 2004 International Congress on Lupus, New York City,

with ph Ahearn, M.D., co-director, Lupus Center of Excellence, University

of Pittsburgh Schools of the Health Sciences; M.A. Toloza, M.D., the

University of Alabama at Birmingham; Chin Lee, M.D., division of rheumatology,

Northwestern University, Chicago; Yelin, Ph.D., division of rheumatology

and Institute for Health Policy Studies, University of California, San

Francisco

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