From the Archives: Fall 2008 issue of Lupus Now
Healthy Environment
Viruses, tobacco, L-canavanine -- we discussed these triggers of lupus disease and flares in the Summer issue of Lupus Now. There are many factors that may contribute to the development of lupus. But before we can try to avoid the triggers, we need to be able to sort facts from fiction.
FICTION: Women with lupus shouldn't get pregnant. While this was the prevailing opinion several decades ago, successful pregnancies are now the norm for women with lupus. The increase in levels of estrogen and prolactin (a hormone linked to inflammation) and possible necessary changes in medications can lead to increased flares during the first and second trimesters and immediately after delivery -- though if you're in remission when you become pregnant, flares are often mild and easily treated. Also be aware that if you have organ damage, pregnancy can increase the risk of kidney failure and hypertension, and a warning has been added to the label of mycophenolate mofetil (CellCept®) about the risks of early pregnancy loss and birth defects.
FACT: Some medicines cause symptoms of lupus. Recently, TNF inhibitors used to treat arthritis (such as Enbrel®, Humira®, and Remicade®) have been found to cause flares of lupus. However, more than 70 drugs have been implicated in triggering drug-induced lupus. The best-known culprits are procainamide (to treat irregular heart rhythms), hydralazine (to treat high blood pressure or hypertension), and isoniazid (to treat tuberculosis). The good news? Because drug-induced lupus is not true lupus, symptoms go away once the triggering medication is stopped. Side effects of Accutane®, used to treat severe acne, also can mimic lupus symptoms, including vasculitis (inflammation of blood vessels), stroke, fatigue, hair loss, and photosensitivity. Talk to a dermatologist about alternative acne treatments; you also may want to discuss your skin care with a nutritionist.
JURY IS STILL OUT: Mercury can trigger lupus. Scientists remain uncertain about the true impact of mercury on humans. A 2003 study at the University of Maryland found that exposure to low levels of mercury can speed up and worsen the symptoms of lupuslike disease in mice, even when the exposure occurs before the development of the disease. The researchers stressed that, while the mercury exposure does not cause lupus, mercury can act as a disease modifier for lupus and might either lower the threshold of susceptibility or increase the severity of the disease. In addition, the U.S. Food and Drug Administration is considering new rules that may lead to revised labeling and possibly controls on mercury use in dental amalgams, even though repeated studies at a variety of scientific institutions have not shown evidence that mercury in fillings poses a health hazard.
FACT: Stress makes it worse. If all this has you panicked, relax. Seriously -- mental stress may cause flares and can increase fatigue, leaving your body ill-equipped to battle the joint pain, fever, and blood abnormalities that accompany mild and severe flares. But, stress-reduction activities such as mild aerobic exercise or meditation have been shown to lessen fatigue and create a sense of well-being. And that will leave you feeling more in control.
-- Emily Wojcik