Dr. Maggie Cadet Blog Highlight

In May for Lupus Awareness Month we were able to have a live candid conversation with Dr. Maggie Cadet. She gave us some great information and is our blog highlight for the day.

May was Lupus Awareness Month and I was honored to speak with @lupusincolor about this important autoimmune disease which can target so many organs.

This disease particularly is important to me because of the impact on women’s health and the Black community. The Lupus Foundation of America estimates that 1 in 250 African American women will develop lupus and Research has shown that Black, Asian and Hispanic patients may experience more complications the disease at a more rapid rate once a diagnosis is established.

It is my pleasure to educate all communities but particularly the Black and minority communities about this autoimmune disease so they may be equipped to take action and battle this disease. I am supporting Lupus warriors of all shapes, colors and sizes!

HERE ARE SOME COMMON LUPUS MYTHS:

MYTH #1: LUPUS only affects women?

TRUTH: Although 90% of individuals who are affected are females of minority populations, Lupus CAN affect males and many times the disease may be worse at diagnosis and may have kidney and skin involvement. Males need to be aware of symptoms so there is not a delay in diagnosis and treatment! Men can’t be afraid to seek help and ask questions about their symptoms if Lupus is a consideration as a diagnosis.

MYTH #2: There is a single type of lupus.

TRUTH: Lupus is an autoimmune disease that causes your immune system to produce proteins called auto antibodies to attack your own tissues and organs instead of a foreign agent or substance. Sometimes lupus can be limited to the skin only called cutaneous lupus. Lupus can affect babies/fetuses as well. There are 4 types of lupus:

1) Cutaneous (Skin) Lupus- You can have a purple or red rash or scarring lesions, hair loss or discoloration

2) Drug Induced lupus (DILE)- may be caused by certain medications such as hydralazine for high blood pressure, isoniazid for tuberculosis, minocycline (antibiotic, procainamide and quinidine (anti-arrhythmics), TNF inhibitors used for rheumatoid arthritis. Procainamide and hydralazine appear to have the highest risk for developing this type of lupus.

3) Neonatal lupus- Affects the newborn infants of women with lupus when certain antibodies in the blood (Ro/SSA and La/SSB antibodies) cross the placenta from mother to the fetus. It is rare but can present as a red rash or skin eruption, low white blood cells or platelets, liver disease and some may develop heart symptoms or congenital heart block.

MYTH #3: You can’t get pregnant or consider having a family if you have Lupus

TRUTH: Women CAN have a full term pregnancy but some may experience bouts of infertility or pregnancy related issues.. The processes that are involved in the immune response of females with Lupus patients are more at risk for

– Still births

– Preeclampsia

– Preterm births

– C sections

There are resources for family planning which include The American College of Rheumatology (ACR) Reproductive Health guidelines and also the HOP-STEP website/program for Lupus patients which is found on line. There are medications that treat lupus that are also compatible with pregnancy like Plaquenil or Imuran. It is recommended that patients should try and be in remission or have low clinical disease activity for at least 6 months before considering pregnancy. Also, women should discuss birth control options with their physician until it is time to think about becoming pregnant.

MYTH#4: There is no overlap with Lupus and COVID-19

TRUTH: There may be an overlap in symptoms with Lupus and COVID-19 infection.

Patients with lupus may be at more risk for contracting the virus because of their already immunocompromised state and the medications these patients are on like steroids which may further suppress the immune system. Please call your doctor if you are experiencing the symptoms below.

Signs of Symptoms of SLE/Lupus flare

– Fever

– Extreme fatigue

– Headaches, neurological symptoms

– Shortness of breath

– Hair loss

– Weight loss

– Joint pain, joint swelling and muscle aches

– Rash on face (butterfly rash, discoloration, scarring rash)

– Swollen glands

– Loss of appetite

– Chest pain

– Leg and facial swelling, foamy or dark or red urine- may indicate kidney disease

– New clots if associated with antiphospholipid syndrome

COVID-19 SYMPTOMS IN ADULTS

– Fever

– Fatigue

– Cough (dry)**

– Headache

– Body aches

– Discoloration of feet (“COVID toes”), other rashes

– Sore throat

– Chills

– Loss of taste and smell **

– Nausea and diarrhea

– Respiratory failure

– Blood clotting abnormalities

-No symptoms at all!!

A rheumatologist will have to do blood work, urinalysis, chest radiograph and assess symptoms to determine if further evaluation for COVID infection is needed. Currently investigation for optimal COVID treatment is still being conducted. Steroids and other immunosuppressants work for Lupus. Ironically a recent study conducted in the UK has shown Dexamethasone (orally or IV) to improve survival in critically ill COVID19 patients requiring oxygen or a ventilator.

Let’s get informed to Fight This Disease!

With love,

Dr. Maggie Cadet

NYC rheumatologist

Associate Attending, NYU Langone

www.maggiecadetmd.com