Selena Gomez Goes Public with Lupus Diagnosis

Actress, singer, fashion designer and celebrity Selena Gomez’s revelation that she has been undergoing chemotherapy for lupus is raising the profile of the not well-understood disorder. A Grand Prairie, Texas, native, Gomez, 23, went public about her struggles with lupus recently, explaining to Billboard’s Joe Lynch that her recent hiatus from performing was, contrary to rumors and gossip, not due to rehab for substance abuse addiction, but because: “I was diagnosed with lupus, and I’ve been through chemotherapy. That’s what my break was really about. … I wanted so badly to say, ‘You guys have no idea. I’m in chemotherapy. You’re assholes.’ I locked myself away until I was confident and comfortable again.”

Systemic lupus erythematosus (SLE) is a severe, disabling systemic and chronic autoimmune disorder of unknown cause in which various cell types and pathways in the body’s immune system dysfunction and produce antibodies that attack and destroy healthy tissue — causing pain, swelling, and inflammation, and damage to skin, joints, and/or organs, including potentially the blood, heart, brain, kidneys, lungs, bones, and nervous system.

Lupus primarily affects women of childbearing age and while men, children, and people of all races and ethnic groups can develop lupus, according to The Lupus Foundation of America, the disease is two to three times more prevalent among African-Americans, Hispanics/Latinos, Asians, Native Americans, Alaska Natives, Native Hawaiians and other Pacific Islanders — than it is among Caucasian women and other demographic categories. Other risk factors for lupus include exposure to sunlight, some prescription medications, infection with Epstein-Barr virus, and exposure to certain chemicals.

Lupus symptoms vary from one person to another, and can range from mild to life-threatening. Some patients with mild symptoms require no treatment. The Lupus Foundation advises that in many cases, the best treatment approach is provided by a healthcare team that tailors treatment to the individual’s specific symptom, using a wide variety and strengths of medicines. With good medical care, most people with lupus lead full lives and normal life spans. However, it is believed that approximately 10 to 15 percent of people with lupus will die prematurely due to complications. Five-year survival rates are 95% for Caucasians, 90% for blacks, and 87% for Latinos. Men, people from lower socioeconomic demographics, and people with kidney disease have lower five-year survival rates with SLE. Leading SLE-related causes of death are nephritis and accelerated atherosclerosis.

Prescribed medications will usually change during a person’s lifetime with lupus, and the Foundation cautions that it can take months — sometimes years — before a healthcare team finds just the right combination of medicines to keep a lupus patient’s symptoms under control. Sometimes aggressive therapies are in order. In certain cases, like Selena Gomez’s, lupus is treated with the anti-cancer chemotherapy drug cyclophosphamide (Cytoxan, Neosar) because of its powerful effects on reducing the activity of the immune system.

Other medications used to treat lupus include:

• Steroids or prednisone and related derivatives of cortisone. Steroid creams can be directly applied to rashes. The Lupus Foundation says use of steroidal creams is usually safe and effective for mild or moderate symptoms of lupus such as rashes. Steroids can also be used in higher doses when internal organs are threatened. Unfortunately, high doses are also most likely to produce side effects.

• Hydroxychloroquine (Plaquenil), an anti-malarial drug, is commonly used to help keep mild lupus-related problems, such as skin and joint disease, under control.

• Azathioprine (Imuran) is a medication originally used to prevent rejection of transplanted organs. It is commonly used to treat the more serious features of lupus. (Note, however, that Azathioprine has been associated with elevated risk of developing certain types of cancer, especially skin cancer and lymphoma).

• Methotrexate (Rheumatrex) is another chemotherapy medication used to suppress the immune system. The Lupus Foundation notes that Methotrexate is becoming increasingly popular as a treatment for skin disease, arthritis, and other non-life threatening forms of disease that have not responded to medications such as hydroxychloroquine or low doses of prednisone. However, The National Institutes of Health’s Medline cautions that: “Methotrexate may cause very serious, life-threatening side effects. You should only take methotrexate to treat cancer or certain other conditions that are very severe and that cannot be treated with other medications.”

• Belimumab (Benlysta) is a monoclonal antibody that reduces the activity of white blood cells (lymphocytes) that make autoantibodies. Autoantibodies are important as they cause tissue damage. Belimumab is used to treat lupus that does not involve the kidneys and has not responded to other types of treatments. Belimumab works by blocking the activity of a certain protein in people with SLE, but may not work as well to treat African-Americans with lupus. The New England Journal of Medicine has a study entitled “Belimumab for Systemic Lupus Erythematosus” by Bevra Hannahs Hahn, MD.

• Rituximab (Rituxan) is another monoclonal antibody that reduces the activity of white blood cells (lymphocytes) that make autoantibodies. It is sometimes used to treat lupus that has not responded to other types of treatments.

The Lupus Foundation of America estimates that based on its research at least 1.5 million Americans have lupus, but that the actual number may be as high as 2 million or more. More than 16,000 new cases of lupus are reported annually nationally. Only one new treatment has been approved by the FDA in the past 50 years.

Rheumatologists generally treat people with lupus because the joints and muscles are more typically impacted, but if the disease causes damage to another organ, other specialists will be consulted. For instance, a dermatologist for cutaneous lupus (skin disease), a cardiologist for heart disease, a nephrologist for kidney disease, a neurologist for brain and nervous system disease, or a gastroenterologist for gastrointestinal tract disease, and so on. A woman with lupus who is considering a pregnancy needs an obstetrician who specializes in high-risk pregnancies.

A wide variety of drugs are under consideration for treating lupus. More information can be found at:
http://www.lupus.org/answers/entry/what-treatments-are-being-studied-for-lupus.