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Doctor: Why?
By Paul M. Dake, M.D.

Q: My 16 year old daughter has had joint aches and a rash on both cheeks for quite some time; I finally took her to our doctor about it & was told she probably has lupus and ordered some blood tests. Is this serious?

A: Systemic lupus erythematosus (SLE or lupus) is an autoimmune disease that is usually difficult to diagnose in the primary care setting, because the symptoms are quite common and often attributed to some other cause.

The most common presenting symptoms are fatigue, unexplained weight loss, and fever without an obvious cause, all of which can occur in up to 90% of patients. Joint and muscle pain are reported in up to 95% of patients who are later shown to have lupus. The facial rash you describe is seen in about 1/3 of those later shown to have lupus. SLE is 10 times more common in females than males.

The best initial blood test is an antinuclear antibody (ANA) test, which is positive in about 94% of individuals with lupus, but can also be positive in other situations. Other confirmatory tests are usually ordered by a rheumatologist, a specialist in diseases of inflammation, who should be consulted in any case where lupus is strongly suspected. Lupus is the 10th most common cause of death in women between the ages of 15 & 24 years, though there are effective treatments available.

To learn more about this and many other health topics, visit the American Academy of Family Physicians’ website familydoctor.org, where you can click on the ‘Search’ box in the upper right corner of the website, and enter your topic of interest.

I want to thank Judy J. for suggesting this topic; if you have any particular topic you would like to hear more about, please message me at paulmdake@gmail.com.