On-Call Advice

What is lupus?

Lupus, also known as systemic lupus erythematosus, is a type of chronic autoimmune disorder in which the body’s immune system attacks its own healthy tissues or organs. The resulting inflammation may damage the joints, skin, blood cells, kidneys or other organs. No one fully understands why lupus and other autoimmune responses occur.

Symptoms of the condition vary from person to person, and often come and go. Most people with lupus experience joint pain, often with stiffness, swelling or arthritis; mild to severe fatigue; and a skin rash that may get worse in sunlight. About half of those with such a rash develop a characteristic “butterfly rash” across the nose and both cheeks. Fever that cannot be traced to another cause also may be present. Other symptoms may occur as well, depending on which organs are affected. 

Diagnosis typically is based on the presence of several characteristic symptoms and may be confirmed by tests to check for inflammation in the body, including blood or antibody tests, urinalysis, X-rays and biopsy. 

No cure for lupus currently exists, so the goal of treatment is to control symptoms and minimize organ damage. Treatment varies by person and depends on the organs affected and how severely symptoms are interfering with the individual’s daily activities. In milder cases, doctors may prescribe anti-inflammatory and pain medications to treat muscular or joint pain or swelling, antimalarial medications to treat pain and fatigue, and corticosteroid creams for skin rash. More severe cases may require medications to suppress the immune system. Most people with lupus have the mild form, with occasional symptom flare-ups. 

If left untreated, lupus can lead to complications such as blood clots, destruction of red blood cells, low blood platelets, inflammation of blood vessels, and fluid around the heart or in the lungs. Having lupus also raises a person’s risk of having a heart attack or stroke. 

People living with lupus should see their doctor regularly, avoid getting too much exposure to sunlight, stay current with immunizations, engage regularly in heart-healthy physical activity, and eat a balanced, healthy diet.

What are blood clots, and why are they dangerous?

A clot is a clump of blood cells and other blood components that forms in the blood. In response to an injured artery or vein, clot formation is normal, helping to stop bleeding and promote healing. After such a wound heals and the clot is no longer needed, the body releases chemicals to dissolve the clot. 

Sometimes inappropriate clotting can take place, however, obstructing normal blood flow. In some cases, clots form in one part of the body and then migrate to another area, where they can cause harm. These dangerous clots may form for a variety of reasons, including due to surgery or trauma; in response to plaque, a fatty substance that builds up gradually inside arteries; or due to health problems like heart disease or high blood pressure. Factors that increase a person’s risk of forming dangerous clots include smoking, obesity, prolonged lack of physical activity, advanced age, some forms of hormone therapy and certain genetic factors.

Common symptoms of blood clots include pain and swelling, with other varying effects throughout the body. For instance, clots in the legs often make it painful to walk, while clots in the lungs may produce chest pain and shortness of breath. In some cases, a potentially life-threatening condition known as pulmonary embolism occurs when a blood clot travels to a lung and blocks the flow of blood. When a clot blocks a coronary artery, the result may be angina (chest pain) or a heart attack. When a clot blocks a carotid artery, which supplies blood to the brain, or blocks a vessel inside the brain, it may cause a stroke. Clots in the kidney may lead to high blood pressure or kidney failure.

Medications for preventing the formation of blood clots include anticoagulants (“blood thinners”) such as warfarin, heparin, apixaban (Eliquis®) and rivaroxaban (Xarelto®). In addition, so-called “clot buster” medications can be used to dissolve clots. In serious cases, doctors may perform a minimally invasive catheter-based procedure that involves inserting a long, thin tube into an affected blood vessel to remove a clot. Occasionally, a more extensive procedure known as a thrombectomy may be performed to remove a clot. 

People can lower their risk of developing blood clots by eating a healthy diet, maintaining a healthy weight, staying physically active and not smoking. 

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