Ask the Experts: Fall 2006 Lupus Now Magazine
Q: I was diagnosed with a mild case of lupus when I was 16. Two years later, after being treated with Plaquenil(r), my lupus went into remission. I haven't had a flare since and have been off Plaquenil for nine years. However, when I catch a common cold or flu, I seem to get knocked out more severely than other people. Can this be attributed to my lupus? I just don't understand how lupus just "went away." Also, when you're in remission, is your immune system weaker than the average person or is it just as strong as it was before the lupus diagnosis?
A: It's good to hear you are doing so well for so long. It's a bit difficult to know exactly what makes you feel more ill than others when you get a viral infection. Infections are known to trigger lupus flares, and one possibility is that you may experience a reactivation of your lupus. A subset of people with lupus also have more trouble with infections, even during remission, than do others. This is a known problem if the person is still receiving immunosuppressive medications for their lupus. However, some are susceptible even without the medications. Current thinking is that lupus develops when a person with certain, predisposing genes is exposed to something in the environment that activates the disease. Those people with increased susceptibility to infections may have inherited certain genes that increase susceptibility to infections as well as to lupus. The genes plus environment concept may also explain why lupus "goes away" in some people. If the environmental trigger isn't there, the disease may not reactivate.—Bruce Richardson, M.D.
Q: How does diabetes affect my lupus and vice versa? What can I do when either gets out of balance?
A: Diabetes and lupus are both chronic diseases that can increase the risk for kidney damage, high blood pressure, and heart disease. Keeping lupus under control and blood sugar under control are paramount. Modifying all other risk factors for heart disease and avoiding medications that are toxic to the kidneys or raise blood pressure might be of some help.—Joan T. Merrill, M.D.
Q: In 1997, I was diagnosed with lupus. In the beginning my doctor sometimes said "lupus," and sometimes "connective tissue disease." Why?
A: Lupus is one of the several illnesses that have been considered connective tissue diseases. This is an old-fashioned term, but it still used in confusing cases when the diagnosis is uncertain. This frequently happens to people early in the course of lupus.—Joan T. Merrill, M.D.
Q: I have lupus and I don't have medical insurance. Does the Lupus Foundation of America know of insurance companies for people with pre-existing conditions such as lupus?
A: A pre-existing condition is a medical condition that has been diagnosed and treated before an individual enrolls in a health plan. The LFA does not have a list of insurance companies that are able to write policies for people with chronic or pre-existing conditions such as lupus. Because every state has different insurance standards and regulations and considerations under group health plans, the general recommendation is to contact the State Department of Insurance at www.naic.org or call (816) 842-3600 for insurance coverage information in the state where you live.
It's important to discuss the particulars of your current health situation with a qualified expert to find the best options that are available to you. Know the type of insurance that best supports your needs before making a decision about securing a particular healthcare plan. These resources also may be helpful:
The Department of Health and Human Services website (www.hhs.gov) provides facts about federal healthcare laws, including information on the Health Insurance Portability and Accountability Act (HIPAA) on the Centers for Medicare and Medicaid Services website at www.cms.hhs.gov (search "HIPAA"). HIPAA is a federal law that states that a pre-existing condition will be covered without a waiting period when an individual joins a new group plan if that individual has been insured for the previous 12 months.
The Georgetown University Health Policy Institute has written consumer guides for each state on getting and maintaining health insurance. The guides are available on their website at www.healthinsuranceinfo.net or by phone at (202) 687-0880.
The Council for Affordable Health Insurance, www.cahi.org, offers consumer information on health savings accounts, high-risk insurance pools, contact information for state departments of insurance, and glossary of terms.—Sharon Mack
Bruce Richardson, M.D. is a Professor of Medicine at the University of Michigan in Ann Arbor and a member of the Lupus Now Advisory Board.
Joan T. Merrill, M.D. is Head of the Clinical Pharmacology Research Program at Oklahoma Medical Research Institute in Oklahoma City. She also serves as the LFA Medical Director.
Sharon Mack researches and responds to inquiries as one of the LFA's health educators. Her professional experience includes program development, implementation, and management of patient and family education and other support programs.