Women of Color Most Likely to Have Lupus
October is Lupus Awareness Month

Women of color - African-Americans, Hispanics, American Indians and Asians - have higher rates of Systemic Lupus Erythematosus, also called SLE or lupus, than Caucasians.

On the other hand, "All men have a more severe course. I have to pay close attention to all my patients, but especially the male patients and look for possible complications," observes Sandra L. Sessoms, M.D., a board-certified rheumatologist at Baylor College of Medicine and a member of the medical advisory board of Baylor's Linda and Ronald Finger Lupus Research Center.

Several studies conclude that there is more severe renal, neurologic, and vascular disease in men with SLE than in women. Such findings, however, have not been confirmed and more research is needed. There also is evidence that lower testosterone levels in both young and older men may predispose these men to autoimmune-like diseases.

Although anyone can get lupus at any age, it primarily strikes women in the childbearing years, ages 15 to 45, and can range from mild to life threatening. There is no cure or known cause for this chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood, heart and kidneys.

"We can make a diagnosis easier now because of the tests we have, but some chronic illnesses like lupus can take longer to diagnose," explains Sessoms.

Before a formal diagnosis of lupus can be made, a patient must have at least four to five symptoms out of a panel of 11: a rash over the cheeks, discoid rash (red-raised patches), sensitivity to light, ulcers in the nose or mouth (usually painless), arthritis, pleuritis or pericarditis (inflammation of the lining of the lung or heart), kidney disorder (excessive protein in the urine), neurologic disorders (seizures, convulsions and/or psychosis), hematologic disorder, antinuclear antibody, and immunologic disorder.

"It is very important to establish the correct diagnosis because treatment is dependent on the symptoms, the laboratory data and the severity of the disease. After diagnosis, the patient must be monitored carefully," she emphasizes.

With all chronic disease patients, depression can be a serious problem, and Sessoms works with her patients on coping skills.

"When I see a patient who is depressed and feels hopeless, that person will have a poor prognosis. Patients with a chronic disease must take control of their lives. I tell them, 'You have a chronic disease, but you can cope.'"

Education and communication are the keys, Sessoms says. She talks to her patients about their problems and calms their fears.

"I give them a therapeutic plan to deal with the illness. We talk about the different things that could happen and what we will do in response to each one."

Another challenge is that rheumatology is not clear cut and no one test can define an illness, she comments. The physician has to be comfortable with not knowing what exactly is wrong with the patient.

"Sometimes I cannot be specific, and I have to convey this to patients without making them feel insecure or uncomfortable," says Sessoms, who received her medical degree from Baylor in 1978.

On the Baylor faculty since 1983, today she is holder of the Linda and Ronny Finger Foundation Professorship in Rheumatology and an associate professor of medicine.

In the early 1980s, while doing her rheumatology fellowship at Baylor, Sessoms was one of a handful of people who hosted meetings for the Lupus Foundation in Houston to support lupus patients and their families and to share information. Those meetings became the Texas Gulf Coast chapter, and today she is a member of its medical advisory board.

- Nora Shire

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URL: http://www.tmc.edu/tmcnews/10_01_02/page_17.html