Ask the Experts -- Summer 2005
Q: Can sunlight cause damage to internal organs in people with lupus, without any outward signs?
A: The short answer to your question is that it is possible, although it is difficult to find experimental evidence directly proving that sunlight causes damage to organs without symptoms that are easily detected.
The longer answer is that it is widely believed that sunlight exposure can trigger a lupus flare, and the flares can take many forms that can affect different organs in different people. Many of the consequences have prominent symptoms, such as skin rashes, arthritis, seizures, and pleurisy, or inflammation of the lining of the lung. However, not all internal organs produce easily detected symptoms when damaged by a lupus flare. Kidney involvement in lupus often does not cause symptoms until significant damage has occurred, and a flare characterized by kidney involvement might be hard to detect without some laboratory studies.
Therefore, it is possible for sunlight to cause internal organ damage in people with lupus without immediately obvious outward signs. However, this question has not been directly tested in controlled studies.
The best thing to do is be sure to minimize sun exposure as best as you can. -- Bruce Richardson, M.D., Ph.D.
Q: Does lupus always eventually go into remission?
A: The simple answer is no. The more complex answer is that, for the majority of patients, the disease is characterized by periods of flares (i.e., active disease) and periods where things are relatively quiescent (i.e., inactive disease). In the latter situation, quiescence is usually achieved with medication.
Remission may be harder to define. One definition is that there are no symptoms, the patient is taking no medications, and all tests -- including the antinuclear antibodies -- become normal. In my study published 20 years ago, fewer than 6 percent of patients achieved that goal.
Therefore I prefer to say that lupus may often become quiescent, but some medication may be required to keep it that way. -- Peter Schur, M.D.
Q: Can I pass along the antiphospholipid antibody syndrome to my child while I am pregnant?
A: The answer to this question really has two parts. The first is that the antiphospholipid antibodies can be a cause for a miscarriage or other pregnancy complications in the second trimester. In that case it is not really the syndrome being passed to the baby, but rather that the mother’s antibodies have caused a blood clot or other complications in the placenta, and because of this the fetus cannot get oxygen and nutrients from the mother. But the other part of the question seems to relate to genetics. I do not believe this has been formally studied. We do know there is a higher tendency for a female child born to a mother with lupus to go on to develop lupus herself, but this occurrence is certainly not higher than one in 10. Specifically with regard to the antiphospholipid syndrome, the inheritance of the propensity to make antiphospholipid antibodies may in fact be higher than for babies born to otherwise healthy mothers. However, the chance of this happening is probably very low. -- Jill Buyon, M.D.
Q: Is there anything I can add to my diet that could lower the inflammation that lupus causes?
A: There has been considerable interest in the influence of dietary factors on many different autoimmune diseases, including lupus. Much of this interest has focused on omega-3 fatty acids because of their potential effects on inflammation. Animal fats are a source of omega-6 fatty acids. Fish, flaxseed and canola oils, and green, leafy vegetables are sources of omega-3 fatty acids. The relative amount of omega-6 and omega-3 fatty acids in the diet affects the types of prostaglandins and other compounds the body produces that influence the inflammatory response. The omega-3 fatty acids in particular result in the production of more anti-inflammatory compounds.
There has been one large study of dietary factors in relation to lupus disease activity. In this study of 216 lupus patients in Japan conducted by Yuko Minami, M.D., there was no association found between intake of total fat, type of fat, or omega-3 fatty acids and subsequent disease activity over a four-year period. However, higher intakes of antioxidants (for example, vitamins C and E) were associated with decreased disease activity.
Thus, although currently available studies suggest that diets high in antioxidants -- and possibly omega-3 fatty acids -- may help lupus symptoms, this is still an unanswered question. The role of antioxidants in disease progression and activity is a relatively under-studied area of research.
It is important to discuss any major change in your diet, especially changes that include use of dietary supplements, with your doctor. There may be potential interactions with prescribed medications or other aspects of your care that are important for your physician to evaluate. -- Glinda Cooper, Ph.D.
Bruce Richardson, M.D., Ph.D. is in the Division of Rheumatology at the University of Michigan, Ann Arbor. He is a member of the Lupus Now Advisory Board.
Peter Schur, M.D. is in the Department of Rheumatology at Brigham & Women’s Hospital in Boston. He is a member of the Lupus Now Advisory Board.
Jill Buyon, M.D. is in the Department of Rheumatology at the Hospital for Joint Disease in New York City and also practices at New York University Medical Center. She is a member of the Lupus Now Advisory Board.
Glinda Cooper, Ph.D. is in the Division of Intramural Research in the Environmental Diseases in Medicine Program, Epidemiology Branch, of the National Institute of Environmental and Health Sciences in Durham, NC.