For me, it’s hard to talk about lupus without talking about RA because I have both illnesses.
As of November 2013, it was reported that 1.3 million adults in the United States have RA and between 161,000 to 322,000 have lupus (1). However, the prevalence rate for lupus may be higher given its difficulty in diagnosing, as the American College of Rheumatology calls lupus ‘the great imitator’ at its range of symptoms and ability to mirror other illnesses (2).
In lupus, the immune system attacks the body’s own tissues, and RA attacks the joints, but both can cause problems with all organ systems of the body; lupus most commonly impacts the skin, kidneys, lungs, and nervous system.
Like RA, lupus is a chronic, autoimmune disease. It can have periods of flare and periods of remission. And lupus is most common in women of childbearing age (15-44 years old), although it is two to three times more common in African American women than Caucasian women.
Common symptoms of lupus are fatigue, headaches, painful/swollen joints, fever, a butterfly rash across the cheeks and nose, photosensitivity, hair loss, and mouth or nose ulcers.
I like to say that lupus makes me feel like I got hit by a Mack truck, I wake up feel plastered to a wall. It’s like being hungover without the fun of having actually had any alcohol to drink.
There is no single laboratory test that can confirm a lupus diagnosis; however the American College of Rheumatology has designated 11 criteria for diagnosing lupus, of which the patient must be positive for at least four to garner a lupus diagnosis (3):
- Malar rash
- Discoid (skin) rash
- Mouth or nose ulcers
- Cardio-pulmonary involvement
- Neurologic disorders
- Renal (kidney) disorder
- Hematologic (blood) disorder
- Immunologic disorder
- Antinuclear antibodies (ANA)
The drugs used to treat lupus and RA are somewhat similar and somewhat different.
To treat lupus, corticosteroids are used, as well as antimalarials, such as hydroxychloroquine/Plaquenil, Benlysta (a monoclonal antibody), and aspirin.
I have also been, and I know others with lupus, who have been on anti-organ rejection medications such as CellCept. I am currently on Tacrolimus, which is another drug in the same class as CellCept.
To treat RA, medications used include analgesics (Tylenol or opioids), biologics (TNF Inhibitors: Humira, Cimzia, Enbrel, Simponi, Remicade; B-Cell Inhibitor: Rituxan; IL-1 Inhibitor; Kineret; SCM: Orencia; IL-6 Inhibitor: Actermra), corticosteroids, DMARDs (Imuran, Cytoxan, Plaquenil, Arava, Xeljanz), and NSAIDs (Ibuprofen and Naproxen).
For me, the drugs used to treat lupus and RA have proven to be one of the biggest obstacles of having these two illnesses. I went on Humira to help with my RA, and it made my lupus flare to the point where I couldn’t get out of bed for two weeks. So to make a long story short, no more Humira for me.
Recently, in my physiology class, someone asked if lupus and RA typically occur together. Our professor said that they are similar diseases. I saw this as a teaching moment, and I explained to the questioner that, in fact, lupus and RA do NOT typically occur together. I did tell her, however, that many autoimmune diseases beget others. That’s why so many of us with lupus or RA also have secondary conditions such as Raynaud’s phenomenon and Sjogren’s Syndrome. The other thing that is true, is that many people with lupus have arthritis, but not necessarily the kind of arthritis that does permanent joint damage as RA does.
So the reality is that lupus and RA are similar and different. They are not the same illness. They impact patients in different ways. But lupus is known for looking like a lot of other diseases, thus making it extremely hard to diagnose and treat.