From the Archives: Summer 2008 issue of Lupus Now
More Than Your Share: Lupus In Overlap with Other Diseases
by Jaclyn Law
For Jane Chappell, everyday life can be debilitating. In 1999, the 41-year-old from Sharpsburg, GA, was diagnosed with lupus, Sjögren’s syn-drome, and Raynaud’s phenomenon -- all autoimmune diseases. Each brings a range of issues including fatigue, joint pain, dry eyes and mouth, and problems with memory and confusion.
Dealing with the diseases takes a heavy toll, she says. "I see a lot of different doctors, and it can be exhausting," says Chappell. "Most of my doctors are in Atlanta, which is a 45-minute drive. I can’t drive myself, so I have to find someone to take me -- that’s sometimes difficult because my husband travels."
"While lupus most often occurs on its own, a person can be unlucky enough to meet diagnostic criteria for more than one illness," says Michelle Petri, M.D., a rheumatologist at Johns Hopkins University. "If there is more than one autoimmune disease, this may be called an ‘overlap.’"
Statistics vary, but it is believed that between 5 percent and 30 percent of people with lupus can experience symptoms associated with other autoimmune diseases, including Sjögren’s syndrome (SHOW-grins), Raynaud’s phenomenon (ray-NODES), fibromyalgia (FY-bro-my-AL-ja), rheumatoid arthritis, and a combination of connective tissue diseases that may be termed overlap or undifferentiated.
"Genetic predisposition to autoimmune disease explains why two inflammatory conditions can occur in some patients," Petri adds. "In lupus, the immune system makes antibodies against normal self-constituents -- we call this a ‘mistake.’ Once a person has that predisposition, the immune system can make more than one mistake."
People with lupus don’t usually have a close family member (parent, child, brother, or sister) who also has lupus. This only occurs about 10 percent of the time. However, it is common for people with lupus to have relatives (grandparents, aunts/uncles, cousins) with other connective tissue diseases.
Triple Threat
According to Petri, 10 percent of people with lupus have Sjögren’s syndrome, which affects 1 million to 4 million people nationwide. The syndrome causes white blood cells to attack moisture-producing glands, causing dryness of the eyes and mouth. This dryness can be treated with artificial saliva (including lozenges) and prescription eye drops.
Raynaud’s phenomenon is a condition in which exposure to cold or stress makes blood vessels in the fingers, toes, ears, or nose constrict, reducing blood flow and causing numbness or tingling. The skin can also change color to white, blue, or red. It is diagnosed more often in cold climates.
Petri explains that Raynaud’s can present by itself and with lupus, rheumatoid arthritis (RA), or scleroderma, a condition that causes hardening of the skin and can affect the organs. Avoiding the triggers for Raynaud’s (for example, by dressing warmly) can help prevent attacks. Treatments include taking medication to open the blood vessels and carrying hand warmers, pocket-sized chemical packets that stay warm for hours.
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