Dr. David Pisetsky, a translational researcher at the Medical Center of Duke University, recently described his team’s new approach to treating potential Lupus patients. The doctor told the Rheumatologist of how his team realized that in order to give patients optimum care when treating lupus, new diagnostic guidelines must be developed. He said that physicians must learn new techniques in order to fully understand and identify patients’ symptoms and give an appropriate and effective response.
Dr. Pisetski explained that when a new patient complains about fatigue or other conditions, their symptoms are often not addressed because they do not mesh with the classic lupus symptoms. But these symptoms should not be ignored because they generally relate to inflammation which is a major factor in SLE (lupus erythematosus).
One notable difference is that it is easy to validate Type 1 symptoms through lab tests, but it is much more difficult when analyzing Type 2 symptoms.
Dr. Pisetski said that in their new model, fatigue is definitely considered as one of the indications of lupus. He urged doctors and other providers to focus on complaints of fatigue just as they would when managing lupus.
Current Classic (Type 1) Signs of Lupus
Classic lupus (Type 1) includes signs that are measured with an index called SLE Disease Activity. Type 1 includes subtypes such as arthritis, nephritis, and vasculitis. The inflammation associated with these disorders causes painful joints, swelling, and tenderness.
The origin of Type 2 symptoms, as well as its association with inflammation, is unclear. However, it has been established that Type 2 lupus includes common complaints such as fatigue, depression, insomnia, chronic pain, and cognition difficulty. Fibromyalgia may also be one of the symptoms.
About the New Model
Researchers and clinicians at Duke realized over time that some symptoms were not considered to be disease activity when diagnosing lupus. These determinations occurred often despite the symptoms presenting severe distress for the patients.
This led the Duke team to develop a new model that combines both Type 1 and Type 2 forms of lupus. More importantly, the new model will incorporate lupus features that have previously been considered separate and apart from the classic Type 1 symptoms.
Dr. Pisetski said that their effort could be considered a repositioning of where they place the symptoms in the overall measurement of the disease.
He said that the symptoms, often severe, are not part of current well-established measurements, but they should be. These new guidelines will be a comfort to patients who previously had their symptoms ignored.
A third scenario would be if lupus patients show a mix of symptoms that fall somewhere between both types. This would require a clinical evaluation.
The Landscape Has Changed
Dr. Jennifer Rogers, director at the Duke Clinic for Lupus disease, writes that the new model is revolutionary. With the inclusion of symptoms of fatigue, pain, and depression, doctors will be more motivated to recognize and discuss these symptoms.
Rather than disagreeing with the patient about their symptoms, Dr. Rogers says that now the physicians empathize with the patients. They have a better understanding of their distress and work with the patients in an effort to mitigate their symptoms.
Dr. Rogers believes that by using the new model there will be improved trust and communication between physicians and patients.
Dr. Pisetsky noted that an advantage to this repositioning is improved treatment. He said that immunosuppressive drugs may have been given to patients incorrectly because symptoms were often misread.
The new models offer a higher degree of accurate diagnosis and medications. The doctors suggest that the models may eventually be useful in the study of a variety of rheumatic diseases.
