Monthly Archives: May 2012

Lupus: A History

The disease lupus got its name in the 13th century. A physician named Rogerius, from Salerno in what is now southern Italy gave it the name– the Latin word for “wolf”– because the facial lesions were thought to resemble a wolf’s bite.

A number of physicians wrote about the rashes and other dermatological signs of lupus over the ensuing centuries. The first modern description of the disease, including a discussion of the less visible effects, was created by the dermatologist Moritz Kaposi in 1872.

Kaposi was the first to recognize multiple types of lupus. In some patients, lupus manifests primarily on the skin, while in others the disease affects the entire body, including internal organs. This is what causes the fever and fatigue associated with the disease. Kaposi wrote that lupus:

[M]ay be attended by altogether more severe pathological changes [...] and even dangerous constitutional symptoms may be intimately associated with the process in question, and that death may result from conditions which must be considered to arise from the local malady.

This insight was proven correct in studies in Baltimore and Vienna in 1904. It was vital to helping patients receive proper care, including preventative measures to protect the kidneys, heart, and brain from damage.

The next major finding was the discovery in 1948 of a cell in bone marrow– an important part of the immune system– associated with lupus. This demonstrated for the first time that lupus is a disease of an overactive immune response. Other studies in the 1950s showed that lupus patients tended to have false positives on tests for viral and bacterial illnesses that worked by looking for a characteristic immune response.

It was also in the 1950s that researchers noticed that family history of lupus was a good predictor of the disease. That was when it was determined that the condition could be passed from parent to child. More recent studies have focused on searching for genetic markers for lupus, and could lead to predicting its presence before symptoms begin to appear.

Strides in Detecting and Treating Lupus

Lupus is a notorious mimic. The autoimmune disease is difficult to diagnose because it has such a wide variety of symptoms that two people seldom present with the same set, while at the same, time, there are very few symptoms a patient can display that are definitely not lupus.

Common lupus symptoms include

  • Chest pain
  • Fatigue
  • Fever
  • Hair loss
  • Mouth sores
  • Sun sensitivity
  • A general feeling of being sick.

Unfortunately, these are all common symptoms, which could indicate any of a variety of underlying conditions. The most characteristic symptom of lupus, a butterfly-shaped rash on the face that gets worse in sunlight, is present in about half of lupus patients.

Now, however, new immunological studies are helping doctors better detect and treat lupus. For example, researchers at the University of Alabama at Birmingham recently found that the immune response that causes lupus is the same as that triggered by parasitic worms, but different from the response to viral infections. That could mean that more narrowly targeted immunosuppressant drugs could someday be developed that only reach that particular type of immune activity.

Greater awareness of lupus is also helping get faster diagnoses. Since doctors know to look for lupus, patients with symptoms that may be the disease can be referred for testing to determine if it is.

If you have lupus symptoms, contact a health care provider. Even if you don’t have lupus, chest pains or sustained fever should not be ignored; those symptoms are likely to indicate something.

Treating Lupus

The chronic inflammatory autoimmune disease lupus is estimated to afflict over 1.5 million Americans, mostly minority women between 15 and 44 years old. If you have lupus, you may know there’s no cure. However, you can work with your health care provider on treatments and strategies that will lessen the severity and frequency of flares and help reduce symptoms.

The usual medical approaches are:

  • Aspirin helps reduce inflammation and blood pressure, preventing the coronary artery problems characteristic of lupus.
  • Acetaminophen can alleviate pain, but it has no effect on inflammation, and sustained use can cause liver damage.
  • Prescription or over-the-counter NSAIDs reduce inflammation and help with joint stiffness. NSAIDs are a class of medications, and some may be more effective than others. If you’re taking NSAIDs, be sure your doctor is aware of it, because they can produce urine test results similar to those of a lupus flare.
  • Your doctor may prescribe corticosteroids. These drugs, including prednisone, fight inflammation, but can be habit-forming; you’ll need to taper rather than go off corticosteroids suddenly. In addition, these drugs can have side effects that include acne, enhanced appetite, and irritability.
  • Antimalarial drugs work in tandem with other medications to enhance their benefits while reducing the side effects. These drugs are particularly useful against the characteristic rashes of lupus.
  • Immunosuppressant drugs tone down the body’s immune response, lessening the severity of autoimmune disorders such as lupus, but leaving the patient more vulnerable to infection.
  • Monoclonal antibodies are a new lupus drug that attacks a protein associated with the disease. This is a class of drug called biologic medications that are being investigated for autoimmune diseases.

In addition to medications, pain management methods such as meditation and breathing techniques can offer some patients relief. A medical professional can help you find a solution that works for you.

What is Lupus?

At least 1.5 million Americans have the chronic inflammatory disease lupus. Most of these people are women of childbearing age, though symptoms can appear earlier than that. However, by the nature of lupus, the actual number of cases may be unknowable.

Although some drugs for hypertension or arrhythmia can cause lupus, usually it is an autoimmune disease affecting the kidneys and other internal organs. It can be difficult to detect, because the symptoms often mimic those of other illnesses. As with other autoimmune diseases, it seems to have a genetic component, with a family history of lupus being considered a risk factor.

Other risk factors are being a woman– more than 90 percent of lupus patients are– and not being white, Lupus among African Americans, Asian Americans, Pacific Islanders and Native Americans is more common, often more severe, and typically strikes younger than with white patients. Most women with lupus experience symptoms between the ages of 15 and 44.

The disease lasts a lifetime, but has periods of flare-up alternating with periods of remission. Symptoms of a flare-up include fatigue, fever, light sensitivity and a skin rash, often butterfly-shaped on the face. Long-term there can be mouth sores and hair loss. In some patients, fingernails crack or fall off, and the nail bed can change color or turn puffy. The first sign, however, is often joint pain.

However, lupus symptoms can be very different in different patients, and the disease often resembles other illnesses. Even testing isn’t always a sure thing, and there is in fact no lupus test. Instead, doctors do a variety of tests to gather information about the patient, and will consider the patient’s medical and family history, to determine if lupus may be a specific patient’s illness. These tests include a complete blood count, of all the components of blood; a sedimentation test, timing how long it takes red blood cells to settle in a test tube, which helps measure general health; and a urine test, to measure kidney function.

Because lupus is so hard to identify and distinguish from other ailments, doctors don’t recommend getting any sort of testing unless symptoms are present. If you do have symptoms, however, including a butterfly rash or joint pain, talk to your health care provider.

Can Liposuction Prevent Skin Cancer?

More than two million Americans are diagnosed with skin cancer each year, making it the most common form of cancer in the United States. There’s a lot of focus on prevention– sunscreen, staying out of direct sunlight. Now researchers are on the trail of another possible preventative measure.

A recent study on mice at Rutgers University in New Jersey has yielded results that might apply to humans. Surgery to remove body fat made the mice significantly less susceptible to skin cancer caused by UV radiation. That means that mice who had the surgery were able to more safely be in sunlight. The study found the mice had 75 percent less tumor activity than mice who had not had fat surgically removed.

The study grew out of research into the effects of caffeine and exercise on cancer risk. Caffeine and exercise both reduce tissue fat, though the cells themselves remain. Coffee consumption has been shown to reduce cancer risk in people, but the exact mechanism is still being investigated. This result suggests the fat-reducing properties of caffeine may be part of the explanation, though not all of it.

The result only held with mice on a high-fat diet, suggesting that even if it does work in humans, a balanced diet actually would not confer the same benefits. Mice on a low-fat diet who underwent the surgery showed no difference in risk. Researchers believe this is likely to be due to abdominal fat producing a chemical that raises the risk of cancer; after it is removed, the fat tissue replacing it doesn’t create this compound. It is known that certain types of fat, when included in the diet, have cancer-preventing properties.

Although tumor formation in mice is analogous in some ways to the process in humans, the lead researcher warns that no firm conclusions about the effects of fat removal in humans. Moreover, this does not speak to the effects of other weight loss or fat reduction techniques.

“It would be interesting to see if surgical removal of fat tissue in animals would prevent obesity-associated lethal cancers like those of the pancreas, colon and prostate,” said the scientist, Dr. Allan Conney. “Whether removal of tissue fat in humans which has certain risks would decrease the risk of life-threatening cancers in humans is not known.”

How To Wear Sunscreen

In the United States, skin cancer is the most common form of cancer. An estimated 2 million people are diagnosed each year, one in every 150 Americans. Increasingly, young adults are putting themselves at risk.

Sunburn is both a predictor and a cause of skin cancer. Like tans, it represents damage to skin cells caused by UV rays. UV radiation from tanning beds is as damaging as from the sun, and the World Health Organization has classified them as a carcinogen. Even a single bad burn can double your risk of melanoma, and it may not strike until years later.

In a survey by the Centers for Disease Control and Prevention, half of all adults between 18 and 29 said they’d had a bad sunburn in the preceding 12 months. In the previous survey, five years earlier, only 45 percent reported burning, an all-time low. Another report showed that six percent of adults had used tanning beds or other indoor tanning equipment. There seems to be no indication of why young adults are burning more frequently, particularly since the study also found a rise in the number of people who use sunblock. Experts think they’re not using enough sunblock or are failing to reapply it.

According to the Skin Cancer Foundation, you should look for a sunscreen with an SPF of 15 or higher that protects against both UVA and UVB radiation. The foundation recommends an initial coat of sunscreen 30 minutes before going out into the sun, then reapplying every two hours regardless of SPF rating, more often if you’re perspiring or getting wet.

Most people don’t use enough sunscreen. For optimum protection, you need about an ounce, but many people use less, sometimes as little as a quarter of that amount. You need sunscreen if you’re going to be spending a significant amount of time outdoors, even if you’re not going to be going to the park or the beach or anything like that, and even on cloudy days—40 percent of the sun’s UV output reaches the earth even through a total cloud cover.

Summer is a time for outdoor fun, and you don’t need to miss out on that to avoid burns and skin cancer. By picking the right sunscreen, putting on enough, and reapplying, you can stay protected without having to hide indoors.

Skin Cancer Treatment

The most common form of cancer, skin cancer, also has one of the best prognoses of any form. The five-year survival rate is more than 95 percent, if the illness is properly and promptly treated.

As with most cancers, skin cancer can be most easily and most successfully treated at its early stages. Be alert for early signs such as change in the size of a mole or spot, emergence of new spots that are asymmetrical and have ragged edges, and rough, scaly brown or dark pink lesions on the face and hands. Moles that bleed also may be cancerous.

People with fair skin or who have lifestyles that involve a great deal of sunlight should get regular skin cancer screenings even if they have no symptoms. Discovering pre-cancerous signs before cancer develops is the best way to be sure.

When cancer is discovered, the most common treatment is simple surgery. It sounds drastic, but it’s actually relatively quick, and most patients make a complete recovery in a short amount of time. Surgery is used when the cancer is on the outer layers of skin– basal or squamous cells– and small enough that it can be completely removed. It’s less effective for melanoma, or for cancers that have spread out over a large area or are affecting other organs.

Surgery doesn’t even have to be particularly involved. Very small, early-stage cancers can be dealt with by cryosurgery, or freezing. Liquid nitrogen is applied to the cancer. As it thaws, the affected skin simply comes off, leaving healthy skin behind. Laser therapy can also be used in a similar way if the cancer is small and near the surface. Another treatment, photodynamic therapy, uses light in conjunction with medication that makes the cancer cells vulnerable to it. This treatment provides a certain degree of poetic justice.

Larger or recurring cancers may require what is called Moh’s surgery. In this procedure, layers of affected skin are removed one at a time. This takes less healthy skin while enabling doctors to completely remove the disease.

Radiation and chemotherapy are common cancer treatments, and they are effective against skin cancer as well. For skin cancer, chemotherapy may be topical, applied as a creme rather than in pill form.

If you think you might have skin cancer, talk to your doctor. The doctor can do the needed tests and, if you do have skin cancer, work with you to develop a treatment program that works for you.

Protect Yourself This Summer

Skin cancer is the most common type of cancer, affecting about two million Americans each year. The most common form of skin cancer, melanoma, is expected to account for 75,000 of the 2 million people likely to be diagnosed with skin cancer in 2012.

To prevent skin cancer, it helps to know your risk factors. Here are some things that can increase your odds of the illness:

  • Fair skin, though particularly melanoma can strike anyone regardless of coloration
  • A history of sunburns; each sunburn represents damage to the skin cells
  • Tanning, which is also the body’s response to damage
  • A family history of skin cancer. If it runs in your family, you’re in line for it too.
  • A weakened immune system, for example due to HIV or anti-rejection drugs after an organ transplant.
  • Old age, since like many cancers, skin cancer can take a long time to develop. Damage in adolescence can show up as cancer decades later.

If you have one of these risk factors, it’s all the more important that you protect yourself. However, anyone can benefit from developing sun-safe habits, such as:

  • Try to stay out of the sun from 10 AM to 4 PM, when it does the most damage.
  • Head for shade if you must go out.
  • Put a shirt on, ideally one with a tightly woven fabric to provide full protection.
  • Put on a hat, which will prevent sunlight from harming any of your cells
  • Wear sunscreen. This is, after all, what sunscreen is for.
  • Don’t use tanning booths, which just do damage.
  • Do not burn, or at least try not to.

Following these tips will help you have a fun summer, while avoiding at least one unpleasant reminder of it in years to come.

Signs of Skin Cancer

Summer is when you’re out enjoying the sun. Unfortunately, the sun could be hurting you. Summer fun could lead to skin cancer down the road. The good news is that skin cancer is one of the most survivable forms of cancer, with a mortality rate of less than five percent over five years.

There are three major types of skin cancer. Squamous-cell carcinoma affects the layer of cells immediately under the epidermis. The next layer down is the basal cell layer, where basal cell carcinoma is found. Under that are melanocytes, where melanin is produced. Cancer here, called melanoma, is the most common type of skin cancer. Melanoma can appear even on parts of the skin that aren’t out in the sun. Generally the areas most often affected are the scalp, face, lips, ears, neck, chest, arms and hands.

Early detection is important, as it is for most forms of cancer. If you learn to recognize signs of cancer, you can seek treatment quickly. Patients with squamous-cell carcinoma will see a firm red nodule, while a pearly or waxy bump is a sign of basal-cell cancer.

Self-examinations for melanoma make use of the ABCDEs of cancer detection:

  • A mole or other mark that is asymmetrical, with a different shape on each side,
  • An uneven or ragged border,
  • The mark has multiple colors,
  • The mark is more than a quarter-inch in diameter, about the size of a pencil eraser,
  • The mark is evolving, changing its size or shape from week to week.

Some doctors are using and recommending the so-called ugly duckling approach, looking for marks that look, feel, or change differently from other marks.

If you see any of that, or rough, scaly, brown or dark pink lesions on your face and hands, talk to your doctor. Your health care provider can help you with treatment and prevention to keep your skin safe.

Obese Women Have Higher Arthritis Risk

Rheumatoid arthritis is a for of arthritis the occurs when the body’s immune system attacks healthy joint tissue, mistaking it for an intruder. Autoimmune diseases often have a genetic component, meaning vulnerability to these conditions is inheritable and runs in families. However, carriers frequently avoid displaying symptoms unless a trigger, often in the environment, activates the disease.

These triggers are not always known, although theories abound, and are likely to be different for different conditions. Recently scientists discovered that obese women are significantly more prone to RA. Women are already known to be two and a half times more likely to develop RA than men are, now researchers are developing a deeper understanding of what other factors there are.

Rheumatoid arthritis patients generally experience initial pain in the extremities, and then it moves to the knees, shoulders and hips. The condition can severely limit mobility and impact quality of life. It can also lead to complications such as heart problems, lung disease, osteoporosis and carpal tunnel syndrome.

The study looked at health records between 1985 and 2007, and found a significant increase in the incidence of rheumatoid arthritis, and by 2007 1.5 million adults had the condition. Researchers determined that more than half the increase was due to a rise in obesity. In fact, people with a history of obesity are more than twice as likely to develop rheumatoid arthritis than people at a more normal weight.

Smoking is another risk factor, though it had only a negligible affect on the increase. Both smoking and obesity are linked with inflammation, and that might be part of the reason for the connection with rheumatoid arthritis.

There has been some criticism of the study. Performed by the Mayo Clinic, the research focused on the area around the clinic’s home, Rochester, Minnesota. The patients studied showed very little racial diversity, so further study is needed to determine if that makes a significant difference in the results.

Living a healthy lifestyle and maintaining a healthy weight have lots of medical benefits, and according to the study, can help prevent rheumatoid arthritis. If you’ve been obese in the past, and especially if you have a family history of autoimmune disease, talk to a doctor to determine what you can do to reduce your risks.