Ask the Experts: Summer 2007 Lupus Now magazine
Q. I'm concerned about news reports encouraging people to change all incandescent light bulbs to fluorescent bulbs. Don't fluorescent lights produce ultraviolet rays that are harmful for people with lupus?
A. The issue of lupus photosensitivity is a complex one and one of the least scientifically studied clinical aspects of cutaneous and systemic lupus. It is my opinion that if a standard fluorescent tube lighting source is shielded by a standard acrylic plastic diffuser, there's virtually no significant risk for people with systemic lupus. These plastic diffusers are available from a variety of companies. However, if a person with lupus is exposed to unshielded fluorescent lighting at close distances for prolonged periods of time, then the cumulative exposure to UVB and UVA could be a problem. You may contact Lupus Now Editor Jenny Allan at allan@lupus.org for a copy of my 1993 publication (a Letter to the Editor of the journal Arthritis and Rheumatism) that addresses the issue of ultraviolet light leakage from fluorescent lighting tubes as a risk for lupus photosensitivity. -- Richard D. Sontheimer, M.D.
Q. I am a 54-year-old Latino with lupus. The sun really bothers me; it saps the energy out of me, and I can't tolerate the brightness. What is it about the sun that makes me so sensitive?
A. What you are referring to is not exactly what we rheumatologists consider sun sensitivity (photosensitivity), which is a skin rash that occurs as an unusual reaction to sunlight exposure. We realize, however, that many people with lupus describe the reaction that you have, either in conjunction with skin rashes or not. We know that photosensitivity occurs more frequently in subjects with non-pigmented (white) skin. But there are no data related to a possible different frequency, among Hispanic/Latino people and those of other ethnicities, of the reaction you are experiencing. There are several important variables that affect the frequency and severity of sun sensitivity: the amount of time you are exposed to ultraviolet light, and the type of ultraviolet light (radiation) you are exposed to, which depends on your environment and your location in the world. After sun exposure, some people with lupus may experience a true lupus flare, which may include feeling ill and fatigue. However, in the absence of other features characteristic of a flare, it would be hard to conclude that your reaction could be a lupus flare. Regardless, sun protection is a must for all people with lupus. -- Graciela S. Alarcón, M.D., M.P.H.
Q. Where did the name "lupus" come from?
A. Lupus was probably first observed in the 13th century, and the physician who described it called it "wolf's bite" because of the redness across the cheeks. The term "lupus erythematosus" was first used in 1851 by a French physician named Pierre Cazenave. "Lupus" is the Latin word for "wolf," and "erythema" is the Greek word for "redness" or "blush." As physicians saw more of the disease and understood more about it, a physician named Moriz Kaposi used the terms "lupus disseminated" and "lupus discoid" for the first time in the mid-1800s to describe skin disorders. The famous Sir William Osler first used the term "SLE" in papers he wrote on systemic lupus at the turn of the century; however, it was not until the 1920s and 1930s that SLE was really defined. -- Evelyn V. Hess, M.D., M.A.C.R., M.A.C.P.
Q. Does long-term prednisone use cause diabetes?
A. Cortisone and its analogues are "stress hormones" that prime the body for times of challenge. Thus, the rise in sugar in the body is a natural byproduct of a preparation for stress in tissues of the muscles, brain, and heart, for example. This is why an increase in the stress hormone results in an increase of the body's stores of glucose. Long-term prednisone use can cause diabetes in someone who has a tendency to be diabetic. Moreover, the higher the dose of prednisone, the greater the likelihood that the blood glucose (sugar) level will rise. Obesity and a genetic background that includes diabetes also give a person a greater chance of developing diabetes. -- Robert Lahita, M.D., Ph.D.
Guest Experts
Richard D. Sontheimer, M.D., is professor and vice chairman, Department of Dermatology, and the Richard and Adeline Fleischaker Chair in Dermatology Research, at the University of Oklahoma Health Sciences Center, Oklahoma City.
Graciela S. Alarcón, M.D., M.P.H., is chair of Medicine and Rheumatology, Department of Clinical Immunology & Rheumatology, at the University of Alabama at Birmingham, where she conducts clinical research, cares for patients, and teaches. She is a member of the LFA's Medical-Scientific Advisory Council.
Evelyn V. Hess, M.D., M.A.C.R., M.A.C.P., cares for patients, teaches, and conducts clinical research in the Department of Internal Medicine, Division of Immunology and Allergy, at the University of Cincinnati Medical Center in Cincinnati, Ohio. She is an honorary member of the LFA Board of Directors.
Robert Lahita, M.D., Ph.D., is chairman of Medicine at LibertyHealth, Jersey City Campus, Jersey City, N.J., where he cares for patients and conducts basic and clinical research. He is co-author of Lupus Q&A: Everything You Need to Know.