Not-So-Expert Lupus Treatment

Lupus diagnosis and treatment differs between rheumatologists and other experts

(RxWiki News) The power to control your lupus comes in part from the specialists who work with you. The amount and type of treatment you get may depend on their ability to communicate with one another.

Lupus patients treated by non-rheumatology specialists may be getting less care than those treated by rheumatologists (experts in rheumatic diseases like rheumatoid arthritis and lupus).

This finding suggests that specialists caring for people with lupus may need to communicate more.

"Ask a rheumatology expert about all your treatment options."

Systemic lupus erythematosus (SLE), more commonly known as lupus, is an autoimmune disease that can affect the joints, skin, kidneys, brain, and other organs.

While your family doctor can provide some help, a rheumatologist can guide you through the specifics of lupus treatment.

But are lupus patients getting the expert care they deserve?

Karoline Lerang, a rheumatologist at Oslo University Hospital in Norway, and colleagues recently set out to answer this question.

The researchers looked at how rheumatologists diagnosed and treated lupus patients. Then they looked at how other specialists did the same tasks.

Non-rheumatology specialists were not necessarily worse at their jobs than rheumatology experts. However, patients treated by non-rheumatology specialists were less likely to be tested for antibodies (proteins that fight invaders of the body) to phospholipids (aPLs).

Patients treated by non-rheumatology experts were also less likely to be treated with hydroxycholoroquine (sold as Plaquenil).

Almost 30 percent of people with lupus tested positive for aPLs, showing that aPLs may be a good tool for diagnosing lupus.

Plaquenil is a drug used to treat malaria. However, it has been shown to prevent permanent damage caused by lupus.

Lerang and colleagues studied 325 lupus patients. Of these, 227 had received care only from rheumatology experts. Thirty-four had been in the care of only kidney experts, hematologists (blood disease experts), or infectious disease specialists. The other 64 participants had been cared for by both rheumatologists and other experts.

Patients cared for by non-rheumatology experts had similar disease characteristics as those cared for by both rheumatologists and other experts. In other words, no patients in either group were much worse off than the other.

Yet, only 12 percent of patients solely in the care of non-rheumatologists were treated with hydroxycholoroquine, compared to 78 percent of those in the care of rheumatologists and other experts.

Similarly, only 68 percent of patients in the non-rheumatology groups were tested for aPLs, while 94 percent of those in the care of rheumatologists and other experts were tested for aPLs.

According to the authors, "These findings indicate that more communication between different specialists caring for [lupus patients] is needed, and highlights an area in need of agreement."

The results of the study were published in Rheumatology, an Oxford Journal. 

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Review Date: 
March 22, 2012