Despite affecting more than 50,000 Canadians – mostly women in their child-bearing years – lupus stubbornly persists as one of the most misunderstood medical conditions in the world.
That's largely because no two lupus patients are alike. They can present widely different symptoms: while one patient reports swollen joints and fatigue, another may experience skin rashes and heart problems.
Part of the reason for this is the disease's ability to attack virtually any organ in the human body. Lupus does this by turning the immune system on itself. So instead of protecting against foreign invaders, it targets our organs – from the brain, skin and joints to the bones, heart, kidneys and blood vessels.
Dr. Murray Urowitz and his team in the Arthritis Program at Toronto Western Hospital are hoping to change the public's perception and bring about better understanding and support for critical research projects.
That's why Dr. Urowitz – who's dedicated most of his professional life to studying the mechanisms that underpin the disease – wholeheartedly supports World Lupus Day, an important annual event that falls today, May 10.
Dr. Urowitz, director of TW's lupus clinic, met with
UHN News recently to discuss how events such as World Lupus Day are critical to the pursuit of research and education and can improve the lives of people with the disease.
Q: What is Lupus?
A: Lupus is a chronic disease in which the immune system goes awry and turns on the body. It is a very complex condition. Lupus can cause inflammation in one or more organs in the body. There is no cure and the cause is unknown. It predominantly affects women; 90 per cent of patients with lupus are female.
Q: Why is World Lupus Day important for patients and clinicians?
A: First, there is still insufficient awareness and because of that reason, in some cases, lupus goes undiagnosed, or the diagnosis is delayed. Second, awareness is important for promoting research to our funding agencies – the CIHR (Canadian Institutes of Health Research), the Arthritis Society and the various lupus organizations – but also allows us to highlight the progress we've made.
Q: Have you seen an increase in lupus awareness in the course of your career?
A: Yes, and there are a lot of reasons for that. It is taught more in medical schools and there is some increase in public awareness thanks in part to the support of organizations such as Lupus Canada and Lupus Ontario and due to groundbreaking work done by the incredible stable of clinicians and researchers we have here at UHN.
Q: Why are women more likely to get lupus?
A: The answer is not completely clear. We do know that the most prevalent adult time for lupus is in the estrogen period of life – that is post-puberty to premenopausal – so estrogen definitely plays a role. But there are also genetic factors. We also know that lupus is more common in families. And then there are a number of environmental stimulants.
Q: What are the current treatments?
A: Steroids are commonly used to treat lupus, but there are serious side effects. For example, women can get osteoporosis, which is the death of bones, usually in the hips and knees. This if often so severe that they need joint replacement surgery. That can be devastating for a young woman. It's one of the reasons that it is essential we fund the search for alternative therapies.
Q: Do you have any advice for people who suspect they have lupus?
A: If you have symptoms and a history of lupus in your family, you need to tell your family doctor so that he or she can at least consider that diagnosis. The other thing to remember is that you are not alone. There are a number of supports available in the community and here at UHN.
Q: What are the prospects for a cure or more effective treatment for lupus?
A: I am much more optimistic than I was eight to 10 years ago because of the increase in knowledge of the functioning of the immune system and new drugs being targeted at parts of the immune system. I think in the future a patient will have a much more personalized medicine approach. And there may be a combination of therapies.
