Lupus and the Lungs by Dr. Gilda Diaz-Fuentes


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Lupus and the Lungs by Dr. Gilda Diaz-Fuentes

  1. 1. Lupus and the Lung G Diaz-Fuentes, MD Pulmonary & Critical Division Bronx Lebanon Hospital Center
  2. 2. <ul><li>What is Lupus </li></ul><ul><li>Chronic, more than 6 week duration </li></ul><ul><li>Autoimmune disease that can damage any part of the body </li></ul><ul><li>Our immune (defense) system start attacking our own body- auto-antibodies and this can cause inflammation, pain, and damage in various parts of the body </li></ul><ul><li>Lupus is a disease of flares (symptoms get worst) and remissions (symptoms improve) </li></ul><ul><li>Lupus can range from mild to life-threatening condition </li></ul>
  3. 3. <ul><li>Research estimates that lupus affect at least 1.5 million people in USA </li></ul><ul><li>It is believed that 5 million people throughout the world have a form of lupus </li></ul><ul><li>Lupus strikes mostly women of childbearing age (15-44). However, men and children can develop lupus, too </li></ul><ul><li>In the United States, lupus is more common in people of color -- African Americans, Hispanics/Latinos, Asian Americans, Native Americans, Native Hawaiians and Pacific Islanders -- than in the Caucasian population </li></ul><ul><li>More than 16,000 new cases of lupus are reported annually across the country </li></ul>How important is Lupus
  4. 4. <ul><li>What Causes Lupus </li></ul><ul><li>Genes </li></ul><ul><li>- No gene or group of genes has been proven to cause lupus - Can appear in certain families- 5-13 % chances if a relative has lupus </li></ul><ul><li>Environment- triggers to set of the disease/flare </li></ul><ul><li>- Ultraviolet rays from the sun/ fluorescent light bulbs </li></ul><ul><li>- Drugs like Sulfa, Tetracycline, Penicillin or other antibiotic </li></ul><ul><li>- Infection – viral illness </li></ul><ul><li>- Exhaustion and emotional stress </li></ul><ul><li>- Anything that causes stress physical or mental </li></ul><ul><li>Hormones- sex hormones- estrogen </li></ul>
  5. 5. Which organs Lupus can affect ? ANY organ of the body can be affected !!
  6. 6. Inflammation caused by lupus may affect the lungs in many ways, and can involve the membrane lining of the lungs, the lungs themselves, the blood vessels within the lungs, and the diaphragm. Lupus and the Pulmonary System
  7. 8. 1- Pleura- sac lining the lungs - Pleuritis – inflammation and pain - Accumulation of fluid 2- Lungs - Pneumonitis- Inflammation - Bleeding and alveolar hemorrhage - Scarring of the lungs 3- Muscles around the lung - Inflammation and scarring- atelectasis Pulmonary complications of Lupus
  8. 9. Cardio-Pulmonary complications of Lupus 4- Lung blood vessels - Pulmonary emboli- blood clots - Pulmonary arterial hypertension 5- Cardiac complications - High blood pressure - Pericarditis- sac around heart - Pericardial effusion - Heart disease
  9. 10. Other Pulmonary complications of Lupus 1- Bacterial pneumonia 2- Complications of drugs used for treatment of lupus - Pneumonitis- Inflammation - Infections
  10. 11. <ul><li>Pleuritis- 40-60% </li></ul><ul><li>-Severe, stabbing pain in a specific area or areas of your chest. </li></ul><ul><li>-The pain is made worse with a deep breath, cough, sneeze, or laugh </li></ul><ul><ul><li>-Shortness of breath </li></ul></ul><ul><li>Upper Respiratory Tract Infections </li></ul><ul><ul><ul><li>- An infection caused by bacteria, virus, or fungi is the most common cause </li></ul></ul></ul><ul><li>- Cough, fever </li></ul><ul><li>Pneumonitis due to lupus- rare (1-12%)- High mortality </li></ul><ul><li>- Fever, chest pain, shortness of breath, and cough. </li></ul><ul><li>- Low oxygen in blood and abnormal chest-x-ray, pleural fluid </li></ul>Symptoms of lung involvement
  11. 12. <ul><li>Chronic Diffuse Lung Disease (~9%) </li></ul><ul><li>- Chronic dry cough </li></ul><ul><li>- Chest pain </li></ul><ul><li>- Shortness of breath </li></ul><ul><li>- Swelling of legs </li></ul><ul><li>- Difficulty breathing during physical activity </li></ul><ul><li>Pulmonary Emboli </li></ul><ul><li>- Chest pain </li></ul><ul><li>- Shortness of breath. </li></ul><ul><li>The most common cause of chest pain in SLE is from muscles, connective tissues, or the costochondral joints </li></ul>Symptoms of lung involvement
  12. 13. <ul><li>The symptoms of lupus can mimic those of other illness </li></ul><ul><li>The diagnosis is based on a combination of physical symptoms and laboratory results and for most people is not a one time diagnosis- criteria by American College of Rheumatology </li></ul><ul><li>There are different presentations </li></ul><ul><li>1- New acute or chronic pulmonary symptoms in someone with the diagnosis of Lupus </li></ul><ul><li>2- Symptoms restricted mainly to the lung </li></ul><ul><li>- </li></ul>How do we know whether we have lung problems ?
  13. 14. <ul><li>A thorough physical examination </li></ul><ul><li>Laboratory test for Lupus </li></ul><ul><li>Chest-X-Ray </li></ul><ul><li>Pulmonary Function Test </li></ul><ul><li>Chest CT scan </li></ul><ul><li>Test to check the oxygen in the blood- Arterial blood gases </li></ul><ul><li>Testing of the fluid in the pleura (Thoracentesis) </li></ul><ul><li>Bronchoscopy </li></ul><ul><li>Electrocardiogram </li></ul><ul><li>Echocardiogram </li></ul><ul><li>Biopsy of the lung </li></ul>All those test values must be interpreted in light of the patient’s present status, other correlating laboratory test results, and coexisting illnesses How do we know whether we have lung problems ?
  14. 15. 28 year old lady with history of lupus affecting the joints and skin January 2008 August 2009
  15. 17. For most people with lupus, proper treatment can minimize symptoms, reduce inflammation and pain, and stop the development of serious organ damage Remember The lung problem can be due to - the disease himself - direct complication of the drugs used to treat the disease - complications due to weak immune system due to the treatment or the disease How do we treat the pulmonary problems?
  16. 18. 1- Medications to treat lupus - Anti-Inflammatory - Corticosteroids - Immunosuppressives medication 2- Anticoagulants (blood thinners)- for blood clots and pulmonary hypertension 3- Antibiotics in case of infections 4- Experimental drugs Treatment options
  17. 19. <ul><li>Pleuritis </li></ul><ul><li>- Analgesics- non steroidal </li></ul><ul><li>- Corticosteroids in more severe cases </li></ul><ul><ul><li>- If pleural fluid present- need to make sure there is no infection </li></ul></ul><ul><li>Upper Respiratory Tract Infections </li></ul><ul><ul><ul><li>- Antibiotics in some cases and supportive care </li></ul></ul></ul><ul><li>Pneumonitis due to lupus- mortality up to 50% </li></ul><ul><li>- Oxygen, </li></ul><ul><li>- Make sure there is no infection process </li></ul><ul><li>- High doses corticosteroids </li></ul><ul><li>- Immunosuppressive treatment </li></ul>Treatment options
  18. 20. <ul><li>Chronic Diffuse Lung Disease (~9%) </li></ul><ul><ul><ul><ul><li>- Sometimes need lung biopsy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>- Immunosuppressive treatment </li></ul></ul></ul></ul><ul><ul><ul><ul><li>- Lung transplant controversial </li></ul></ul></ul></ul><ul><li>Pulmonary Emboli </li></ul><ul><li> - Blood thinner- anticoagulation </li></ul><ul><li>Pulmonary Hypertension </li></ul><ul><ul><ul><li> - Need to look for etiology- if blood clot- treat </li></ul></ul></ul><ul><ul><ul><li>- Due to lupus- oxygen, blood thinners and specific medications </li></ul></ul></ul><ul><ul><ul><li>- Refer to specialized centers </li></ul></ul></ul>Treatment options
  19. 21. <ul><li>Avoid sun exposure </li></ul><ul><li>Smoking cessation- Tobacco can increase risk of lupus </li></ul><ul><li>Balanced diet, avoid high cholesterol </li></ul><ul><li>Avoid some medications- sulfa </li></ul><ul><li>Avoid pregnancy during active disease </li></ul>General recommendations
  20. 22. <ul><li>As with any disease, prevention is the best medicine </li></ul><ul><li>Check with your doctor about whether you are at risk of having cardiopulmonary disease from Lupus </li></ul><ul><li>Do not ignore symptoms such as unexplained fatigue, shortness of breath or chest pressure </li></ul><ul><li>Go to your doctor on a regular basis, ask questions, eat right, exercise and try to maximize your situation </li></ul><ul><li>Get all your vaccines- influenza, pneumococcal vaccine </li></ul><ul><li>Watch your heart and lungs! </li></ul>Prevention !!
  21. 23. <ul><li>Lupus can range from mild to life-threatening condition. With good medical care, most people with lupus can lead a full life. The idea that lupus is generally a fatal disease is a big misconception </li></ul><ul><li>The prognosis of lupus is much better today than ever before </li></ul><ul><li>The medical science does not have the cure for lupus yet, however, people with non-organ threatening aspects of lupus can look forward to a normal lifespan </li></ul><ul><li>- follow the instructions of your physician, </li></ul><ul><li>- take the medication(s) as prescribed, </li></ul><ul><li>- know when to seek help </li></ul><ul><li>- learn about the disease and medications </li></ul><ul><li>New research brings unexpected findings each year. The progress made in treatment and diagnosis during the last decade has been greater than that made over the past 100 years </li></ul>Prognosis- Hope for the future !!!
  22. 24. Thanks