Safety campaign reduces medical radiation risks in Africa
When Dr Michael Kawooya, a radiologist at Mengo Hospital in Kampala, Uganda, performs an ultrasonography on pregnant patients he’s often asked, “Doctor, is this dangerous?”
His answer is always “No”.
“Ultrasonographies do not use ionizing radiation, so they aren’t dangerous,” says Dr Kawooya, who is also Director of Ernest Cook Ultrasound Research and Education Institute in Kampala.
Yet many of the procedures his patients do have or ask for, including X-rays, CT-scans and fluoroscopy-guided interventions, do use ionizing radiation. These have the potential to cause cancer and skin injuries, particularly in children. Many referrers, patients and caregivers are unaware of these risks.
“Often patients think that an X-ray is part of a cure without any knowledge of the risks involved,” explains Dr Kawooya. “This is our opportunity to educate them.”
Improving radiation safety
Worldwide, an estimated 3.6 billion diagnostic medical examinations, such as X-rays, are performed every year. This number continues to grow as more people access medical care. About 350 million of these are performed on children under 15 years of age.
“If patients and families are not properly informed about the risks and benefits of an imaging procedure, they may make choices that are more harmful rather than beneficial to their health, such as refusing a CT that is needed or demanding a CT that is not justified,”
Dr Maria del Rosario Perez, scientist with WHO’s Department of Public Health
Using radiation in medical imaging can save lives and prevent the need for more invasive procedures, but inappropriate use may lead to unnecessary and unintended radiation doses for patients. Because children are smaller and have a longer lifespan than adults their risk of developing radiation-induced effects is greater.
“If patients and families are not properly informed about the risks and benefits of an imaging procedure, they may make choices that are more harmful rather than beneficial to their health, such as refusing a CT that is needed or demanding a CT that is not justified,” says Dr Maria del Rosario Perez, a scientist with WHO’s Department of Public Health.
To improve safety WHO launched a Global Initiative on Radiation Safety in Health Care Settings in 2008 with the aim to mobilize the health sector towards safe and effective use of radiation in medicine.
One key priority is to improve the communication of radiation risk in paediatric imaging to ensure an effective and balanced benefit-risk dialogue between health care providers, families and patients.
A new WHO publication, “Communicating radiation risks in paediatric imaging”, helps health-care providers communicate known or potential radiation risks associated with paediatric imaging procedures. The document provides several approaches to help medical professionals answer questions, like “How much radiation will my child receive?” and “How much medical radiation is too much?”
In Uganda, Dr Kawooya and other medical professionals are using the new publication as part of a regional campaign to improve radiation safety and raise awareness to develop national radiation policies and regulations.
A campaign for Africa
In many parts of Africa protecting patients from radiation risks can be a challenge. Radiation guidelines are often inadequate and rarely adhered to. Training for medical professionals is unregulated, and procedures for maintenance, decommissioning and disposal of radiology equipment are not always followed.
In February 2015, the Pan African Congress of Radiology and Imaging launched AFROSAFE, a campaign to ensure all radiation-based medical procedures in Africa are necessary and performed safely. As part of the campaign, medical professionals are learning to conduct risk-benefit discussions about paediatric imaging with patients and families utilizing WHO’s new risk communications tool.
“AFROSAFE is bringing the African medical community together in the struggle to ensure radiation safety,” says Dr Kawooya. “WHO’s new tool will help us create more awareness about the risks associated with radiation exposure, and help use develop communication skills needed to pass on the messages.”
Through AFROSAFE Uganda, Dr Kawooya is teaching doctors and technicians in his country to enhance the safety and quality of radiology. In November 2015, he helped organize the first training session, which was attended by more than 100 Ugandan medical professionals and patient advocates.
On of the training sessions, “To X-ray or not to X-ray,” presented different patient scenarios and asked participants to discuss whether they would refer the patient to medical imaging or not. This scenario reminded medical professionals of the guidelines they should be following to protect all patients.
“We are encouraging radiologists at hospitals throughout Uganda to use referral guidelines when making decisions about using radiation on children and their families,” says Dr Kawooya. “It is our responsibility to help our patients make informed decisions while keeping them safe.”
The new communication tool will serve as a basis to further develop training packages to improve communication skills of health care workers, as well as advocacy and information materials targeting patients, parents, family members, and the community.
Radiation in Medicine: Medical Imaging Procedures
Most people have had one or more medical imaging tests. Imaging procedures are medical tests that allow doctors to see inside the body in order to diagnose, treat, and monitor health conditions. Doctors often use medical imaging procedures to determine the best treatment options for patients. The type of imaging procedure that your doctor may suggest will depend on your health concern and the part of the body that is being examined. Some common examples of imaging tests include:
Medical imaging tests can help doctors:
How can you reduce your exposure to diagnostic ionizing radiation?
In the case of x-rays or other tests involving exposure to ionizing radiation, doctors and radiation experts can help reduce your exposure to and risk of harm from diagnostic ionizing radiation by:
What are the risks of medical imaging procedures for pregnant women?
Talk to your physician about the potential risks and benefits from the medical procedures. In many cases, the risk of an x-ray procedure to the mother and the unborn child is very small compared to the benefit of finding out about the medical condition of the mother or the child.
However, small risks should not be taken if they're unnecessary. You can reduce risks from medical imaging procedures by telling your doctor if you are, or think you might be, pregnant whenever an abdominal x-ray is suggested by your doctor. Other options suggested by FDA that may be considered are as follows:
Are there special considerations for children?
It is important that x-rays and other imaging procedures performed on children use the lowest exposure setting needed to obtain a good clinical image. The Image Gently Alliance, part of the Alliance for Radiation in Pediatric Imaging, suggests the following for imaging of children:
For more information about medical imaging procedures that do not use ionizing radiation, please see Radiation in Medicine: Medical Imaging Procedures.
X-Rays, Pregnancy and You
Pregnancy is a time to take good care of yourself and your unborn child. Many things are especially important during pregnancy, such as eating right, cutting out cigarettes and alcohol, and being careful about the prescription and over-the-counter drugs you take. Diagnostic x-rays and other medical radiation procedures of the abdominal area also deserve extra attention during pregnancy. This brochure is to help you understand the issues concerning x-ray exposure during pregnancy.
Diagnostic x-rays can give the doctor important and even life-saving information about a person's medical condition. But like many things, diagnostic x-rays have risks as well as benefits. They should be used only when they will give the doctor information needed to treat you.
You'll probably never need an abdominal x-ray during pregnancy. But sometimes, because of a particular medical condition, your physician may feel that a diagnostic x-ray of your abdomen or lower torso is needed. If this should happen - don't be upset. The risk to you and your unborn child is very small, and the benefit of finding out about your medical condition is far greater. In fact, the risk of not having a needed x-ray could be much greater than the risk from the radiation. But even small risks should not be taken if they're unnecessary.
You can reduce those risks by telling your doctor if you are, or think you might be, pregnant whenever an abdominal x-ray is prescribed. If you are pregnant, the doctor may decide that it would be best to cancel the x-ray examination, to postpone it, or to modify it to reduce the amount of radiation. Or, depending on your medical needs, and realizing that the risk is very small, the doctor may feel that it is best to proceed with the x-ray as planned. In any case, you should feel free to discuss the decision with your doctor.
What Kind of X-Rays Can Affect the Unborn Child?
During most x-ray examinations - like those of the arms, legs, head, teeth, or chest - your reproductive organs are not exposed to the direct x-ray beam. So these kinds of procedures, when properly done, do not involve any risk to the unborn child. However, x-rays of the mother's lower torso - abdomen, stomach, pelvis, lower back, or kidneys - may expose the unborn child to the direct x-ray beam. They are of more concern.
What Are the Possible Effects of X-Rays?
There is scientific disagreement about whether the small amounts of radiation used in diagnostic radiology can actually harm the unborn child, but it is known that the unborn child is very sensitive to the effects of things like radiation, certain drugs, excess alcohol, and infection. This is true, in part, because the cells are rapidly dividing and growing into specialized cells and tissues. If radiation or other agents were to cause changes in these cells, there could be a slightly increased chance of birth defects or certain illnesses, such as leukemia, later in life.
It should be pointed out, however, that the majority of birth defects and childhood diseases occur even if the mother is not exposed to any known harmful agent during pregnancy. Scientists believe that heredity and random errors in the developmental process are responsible for most of these problems.
What If I'm X-Rayed Before I Know I'm Pregnant?
Don't be alarmed. Remember that the possibility of any harm to you and your unborn child from an x-ray is very small. There are, however, rare situations in which a woman who is unaware of her pregnancy may receive a very large number of abdominal x-rays over a short period. Or she may receive radiation treatment of the lower torso. Under these circumstances, the woman should discuss the possible risks with her doctor.
How You Can Help Minimize the Risks
Sources: Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO)
Allergy Relief for Your Child
Children are magnets for colds. But when the sniffles and sneezing won’t go away for weeks, the culprit may be something else: allergies.
Long-lasting sneezing, with a stuffy or runny nose, may signal the presence of allergic rhinitis—the collection of symptoms that affect the nose when you have an allergic reaction to something you breathe in and that lands on the lining inside the nose.
Allergies may be seasonal or they can strike year-round (perennial). In most parts of the United States, plant pollens are often the cause of seasonal allergic rhinitis—more commonly called hay fever. Indoor substances, such as mold, dust mites, and pet dander, may cause the perennial kind.
Up to 40 percent of children suffer from allergic rhinitis, according to the National Institute of Allergy and Infectious Diseases (NIAID). And children are more likely to develop allergies if one or both parents have allergies.
The U.S. Food and Drug Administration (FDA) regulates both over-the-counter (OTC) and prescription medicines that offer allergy relief as well as allergen extracts used to diagnose and treat allergies. And parents should take particular care when giving these products to children.
Immune System Reaction
An allergy is the body’s reaction to a specific substance, or allergen. Our immune system responds to the invading allergen by releasing histamine and other chemicals that typically trigger symptoms in the nose, lungs, throat, sinuses, ears, eyes, skin, or stomach lining.
In some children, allergies can also trigger symptoms of asthma—a disease that causes wheezing or difficulty breathing.
If a child has allergies and asthma, “not controlling the allergies can make asthma worse,” says Anthony Durmowicz, M.D., a pediatric pulmonary doctor in FDA’s Division of Pulmonary, Allergy, and Rheumatology Products.
Avoiding the Culprit
If your child has seasonal allergies, you may want to pay attention to pollen counts and try to keep your child inside when the levels are high.
For most children, symptoms may be controlled by avoiding the allergen, if known, and using OTC medicines. But if a child’s symptoms are persistent and not relieved by OTC medicines, it is wise to see a health care professional to assess your child’s symptoms and see if other treatments, including prescription medicines, may be appropriate. There are seven options available (see table below) to help bring your child relief. Although some allergy medicines are approved for use in children as young as 6 months, Dianne Murphy, M.D., director of FDA’s Office of Pediatric Therapeutics, has some cautions. “Always read the label to make sure the product is appropriate for your child’s age,” Murphy says. “Just because a product’s box says that it is intended for children does not mean it is intended for children of all ages.”
Another reason to carefully read the label is that even though the big print may say the product is for a certain symptom (sneezing, allergy, cough, etc.), different products may have the same medicine (active ingredient). So it might seem that you are buying different products to treat different symptoms, but in fact the same medicine could be in all the products. The result: You might accidently be giving too much of one type of medicine to your child.
“Children are more sensitive than adults to many drugs,” adds Murphy. “For example, some antihistamines can have adverse effects at lower doses on young patients, causing excitability or excessive drowsiness.”
More Child-Friendly Medicines
Recent pediatric legislation, including a combination of incentives and requirements for drug companies, has significantly increased research and development of drugs for children and has led to more products with new pediatric information in their labeling. Since 1997, a combination of legislative activities has helped generate studies in children for 600 products.
Many of the older drugs were only tested in adults, says Durmowicz. “But we now have more information available for the newer allergy medications,” he adds. “With the passing of this legislation, there should be more confidence in pediatric dosing and safety with the newer drugs.”
The legislation also requires drugs for children to be in a child-friendly formulation, adds Durmowicz. So if the drug was initially developed as a capsule, it has to also be made in a form that a child can take, such as a liquid with cherry flavoring, rapidly dissolving tablets, or strips for placing under the tongue.
In February 2016, FDA approved a generic version of Flonase Allergy Relief, an over-the-counter-allergy symptom reliever nasal spray for the temporary relief of the symptoms of hay fever or other upper respiratory allergies. In March 2016, FDA approved the first generic version of Nasonex spray for the treatment of nasal symptoms of seasonal and perennial allergic rhinitis in adults and children 2 and older.
Jay E. Slater, M.D., director of FDA’s Division of Bacterial, Parasitic and Allergenic Products, who is also a pediatric allergist says that children who don’t respond to either OTC or prescription medications, or who suffer from frequent complications of allergic rhinitis, may be candidates for allergen immunotherapy—commonly known as allergy shots. According to NIAID, about 80 percent of people with allergic rhinitis will see their symptoms and need for medicine drop significantly within a year of starting allergy shots.
After allergy testing, typically by skin testing to detect what allergens your child may react to, a health care professional injects the child with “extracts”—small amounts of the allergens that trigger a reaction. The doses are gradually increased so that the body builds up immunity to these allergens.
Allergen extracts are manufactured from natural substances, such as pollens, insect venoms, animal hair, and foods. More than 1,200 extracts are licensed by FDA.
In 2014, FDA approved three new immunotherapy products to be taken under the tongue for treatment of hay fever caused by certain pollens, two of them for use in children. All of them are intended for daily use, before and during the pollen season. They are not meant for immediate symptom relief. Although they are intended for at-home use, these are prescription medications, and first doses are to be taken in the presence of a health care provider. The products are Oralair, Grastek, and Ragwitek (which is approved for use in adults only).
“Allergy shots are never appropriate for food allergies,” adds Slater, “but it’s common to use extracts to test for food allergies so the child can avoid those foods.”
Transformation in Treatment
“In the last 20 years, there has been a remarkable transformation in allergy treatments,” says Slater. “Kids used to be miserable for months out of the year, and drugs made them incredibly sleepy. But today’s products offer proven approaches for relief of seasonal allergy symptoms.”
Forgoing treatment can make for an irritable, sleepless, and unhappy child, adds Slater, recalling a mother saying after her child’s successful treatment, “I didn’t realize I had a nice kid!”
Fighting Allergy Season with Medications
You’re sneezing, your eyes are itchy and you feel miserable. Seasonal allergies aren’t just a nuisance, they are real diseases that can interfere with work, school or recreation, and can range from mild to severe.
May is National Asthma and Allergy Awareness Month, and many allergy treatment options are approved by the Food and Drug Administration (FDA). For the first time, these include three sublingual (under the tongue) prescription products to treat hay fever (also called “allergic rhinitis”)—with or without eye inflammation (called “conjunctivitis”)—caused by certain grass pollens and short ragweed pollen. The new products—Grastek, Oralair and Ragwitek—can be taken at home, but the first dose must be taken in a health care provider's office.
An allergy is a heightened immune system reaction to a substance that your body has identified as an invader. If you have allergies and encounter a trigger—called an “allergen”—your immune system fights it by making antibodies, which causes your body to release chemicals called histamines. Histamines are responsible for symptoms such as repetitive sneezing and itchy, watery eyes.
Allergic rhinitis affects more than 30 million children and adults in the United States and more than 500 million people worldwide. It may be seasonal or year-round.
The seasonal allergy, often called “hay fever,“ typically occurs in the spring, summer or fall. If you have this, you may suffer from repetitive sneezing, and stuffy or runny nose and itching in the nose, eyes or on the roof of the mouth. Eye inflammation can occur when your eyes react to allergens with symptoms of reddening, itching and swelling.
Plant pollens usually cause seasonal allergies. Pollen allergies are common, and allergy-causing pollen can come from trees, weeds and grasses, according to the National Institute of Allergy and Infectious Diseases. Trees and grasses are typical spring culprits in the United States, while ragweed and other weeds ramp up in late summer and early fall.
Indoor substances, such as dust mites, often cause the year-round type of allergies. Molds can cause seasonal and year-round allergies.
If you suspect an allergy, see your health care provider, as conditions such as upper respiratory infections, sinus infections and eye infections can have similar symptoms.
“The first step is to get appropriate testing to determine what you’re actually reacting to,” says Jay Slater, M.D., an allergist and director of FDA’s Division of Bacterial, Parasitic and Allergenic Products.
Your health care provider can test you using injectable allergen extracts. Allergen extracts are sterile liquids made from natural substances such as molds, pollens or animal hair. FDA has licensed these products. Tests include:
Medications to Treat Symptoms
“After testing, you need to sort out results with your health care provider,” Slater says. “Take the results of the test and combine it with reflective thinking about when and where you’re experiencing symptoms. Then determine the best course of action.”
For instance, if you have a spring oak tree allergy you can try to avoid the allergen by limiting outdoor activities on high pollen-count days and keeping your windows closed. But airborne pollen can be hard to avoid, so your health care provider may also recommend prescription or over-the-counter medications to relieve symptoms.
Antihistamines reduce or block symptom-causing histamines and are available in many forms, including tablets and liquids.
“There are several different antihistamines. First-generation antihistamines include medications such as diphenhydramine, marketed under the brand name Benadryl. They have been available over the counter for a long time,” says Narayan Nair, M.D., a medical officer at FDA. “Newer second generation antihistamines have not been available over the counter as long. They include medications such as fexofenadine and loratadine, which are marketed under the brand names Allegra and Claritin, respectively.”
When choosing an over-the-counter antihistamine, patients should read the Drug Facts label closely and follow dosing instructions, Nair says. “Some antihistamines can cause drowsiness and interfere with the ability to drive or operate heavy machinery. The drowsiness can be made worse by taking sedatives or consuming alcohol,” he explains. “Also, patients with chronic conditions such as glaucoma, or an enlarged prostate should talk to their health care provider before taking certain antihistamines.”
In addition to the antihistamines, nasal sprays and eye drops can help improve some allergic symptoms. “Nasal sprays can help relieve nasal symptoms but they should only be used for a limited time without talking to a health care provider. If some nasal sprays are used longer than intended they can make the congestion worse,” Nair notes.
Medications that Help Desensitize
If you don’t respond to medications to relieve symptoms, you may be a candidate for allergen immunotherapy, often given via “allergy shots” that have small amounts of the allergen. These shots can decrease sensitivity to inhaled allergens.
Patients can receive weekly injections from a health care provider for two to three months, during which time the dose increases, Slater says. After the maximum dose is reached, treatment can continue monthly for three to five years.
The prescription sublingual treatments approved in April—Grastek, Oralair, and Ragwitek—also are an immunotherapy option. “These medications have the potential for dialing down the immune response to allergens, doing more than just treating the symptoms of allergies,” says Slater. Sublingual therapy should start three to four months prior to allergy season so, depending on your geographic location, it may be something to explore in the next year.
Allergenic treatments can result in reactions such as swelling in the place where they are administered, or systemic reactions that can affect the airway. “For injection therapy, local side effects like itching and swelling can be annoying but not life-threatening,” Slater explains. But for the medications taken under the tongue, you must be especially careful to pay attention to side effects such as swelling.
Due to the potential for serious complications, you must take the first sublingual treatment under medical supervision. After that, you can take treatments daily at home, and your health care provider must prescribe an autoinjectable epinephrine device in case you need it for a severe reaction. You should read the medication guide that is distributed with Grastek, Oralair and Ragwitek each time you fill a prescription.
“For sublingual therapy, the fact that it’s not an injection will be an advantage to some individuals. And the fact that, aside from the first visit, it doesn’t require follow-up office visits will also be an advantage,” Slater says.
“What’s limiting for sublingual therapy compared to injection therapy is the availability of products. Now, we have sublingual medications for treatment of allergic rhinitis with or without conjunctivitis caused by short ragweed and certain grass pollens, but plenty of other substances induce allergies and affect people, sometimes dramatically,” Slater continues. “With injection immunotherapy, health care providers have more flexibility in terms of treating patients who may have multiple allergies or allergies not covered by sublingual products.”
Allergy Meds Could Affect Your Driving
If you can literally write your name in pollen on the windshield of your car, you know it is allergy season again.
When your body comes into contact with whatever triggers your allergy—pollen, ragweed, pet dander, or dust mites, for example—it produces chemicals called histamines. Histamines cause the tissue in your nose to swell (making it feel stuffy), your nose and eyes to run, and your eyes to itch. Some people develop itchy skin rashes known as hives.
Medications containing antihistamines, drugs which counteract the effect of histamines, can help relieve many different types of allergies, including hay fever and food allergies.
But some antihistamines can make you feel drowsy, unfocused and slow to react. If not taken responsibly and according to directions, they can pose a danger to your health and safety. Information about whether an antihistamine medication can make you drowsy can be found in the product’s label. Consumers should read the Drug Facts label of the medication and understand the warnings before they use it.
“Any of these reactions can negatively interfere with driving or operating heavy machinery,” says Jane Filie, M.D., a medical officer at the Food and Drug Administration’s (FDA) Division of Nonprescription Regulation Development. Filie says you may experience slower reaction time, haziness, or mild confusion even if you don’t feel drowsy after taking a medication containing antihistamines.
Precautions to Take
FDA wants to promote awareness of the potential health risks and the precautions that you should take when using antihistamines.
Different antihistamines may be dosed differently, says FDA pharmacist Ayana Rowley, Pharm.D. “Don’t assume that when you run out of one antihistamine and happen to buy another, it’s the same dose,” she explains. If one specific antihistamine worked for you before, take note of the dosage and make sure you get the same medication the next time.
It’s also important to avoid taking alcohol, sedatives (sleep medications), or tranquilizers while taking some antihistamines. This information can also be found in the Drug Facts label, Filie says. Alcohol and sedatives can seriously increase the sedative effects that already may occur when taking antihistamines.
Rowley also cautions against self-medicating. “If the correct dosage isn’t providing you the relief you expect, don’t simply keep taking more and more of that product,” she says, “but instead, consult with your health care professional”.
Tips to Keep in Mind
Source: U.S. Food and Drug Administration (FDA)
Systemic lupus erythematosus, referred to as SLE or lupus, is a chronic (long-term) disease that causes inflammation — pain and swelling. It is sometimes called the “great imitator,” because of people often confuse lupus with other health problems due to its wide range of symptoms.
In addition to affecting the skin and joints, it can affect other organs in the body such as the kidneys, the tissue lining the lungs (pleura) and heart (pericardium), and the brain. Most patients feel fatigue and have rashes, arthritis (painful and swollen joints) and fever.
Lupus flares vary from mild to serious. Most patients have times when the disease is active, followed by times when the disease is mostly quiet — referred to as a remission. Yet, there is much reason for hope. Improvements in treatment have greatly improved these patients’ quality of life and increased their lifespan.
What causes lupus?
The immune system is the body’s defense system. When healthy, it protects the body by making antibodies (blood proteins) that attack foreign germs and cancers. With lupus, the immune system misfires. Instead of producing protective antibodies, an autoimmune disease begins and makes “autoantibodies,” which attack the patient’s own tissues. Doctors sometimes refer to this as a “loss of self-tolerance.”
As the attack goes on, other immune cells join the fight. This leads to inflammation and abnormal blood vessels (vasculitis). These antibodies then end up in cells in organs, where they damage those tissues. Why this inflammatory response begins is not clear. It most likely results from a mix of inherited tendencies and things in your environment. These include viruses, sunlight and drug allergies. People with lupus may also have an impaired process for clearing old and damaged cells from the body, which causes an abnormal immune response.
Most often, lupus starts in people in their 20s and 30s. The disease is more common in some ethnic groups, mainly blacks and Asians, and tends to be worse in these groups.
How is lupus diagnosed?
Lupus can be hard to detect because it is a complex disease that has many symptoms, and they can come on slowly. As experts in diagnosing and treating autoimmune diseases such as lupus, rheumatologists can best determine whether a patient has lupus and advise them about treatment options.
People with lupus often have symptoms that are not specific to lupus. These include fever, fatigue, weight loss, blood clots and hair loss in spots or around the hairline. They may also have heartburn, stomach pain, and poor circulation to the fingers and toes. Pregnant women can have miscarriages.
The American College of Rheumatology has a list of symptoms and other measures that doctors can use as a guide to decide if a patient with symptoms has lupus. If your doctor finds that you have at least four of these problems, and finds no other reason for them, you may have lupus:
The presence of antiphospholipid antibodies can help doctors detect lupus. These antibodies signal a raised risk of certain complications such as miscarriage, difficulties with memory, or blood clots that may lead to stroke or lung injury. Doctors also may measure levels of certain complement proteins (a part of the immune system) in the blood, to help detect the disease and follow its progress.
How is lupus treated?
There is no cure for lupus, and treating lupus can be a challenge. However, treatment for lupus has improved a great deal. Treatment depends on the type of symptoms you have and how serious they are. Patients with muscle or joint pain, fatigue, rashes and other problems that are not dangerous can receive “conservative” treatment.
Common treatment options include:
Broader health impact of lupus
Even when it is not active, lupus may cause problems later. Some of these problems can be fatal. One of these problems is atherosclerosis (clogging of the arteries) that may develop in younger women or may be more severe than usual. This problem raises the risk of heart attacks, heart failure and strokes. Thus, it is vital that patients with lupus lower their other risk factors for heart disease, such as smoking, high blood pressure and high cholesterol. It is also important to have as active a lifestyle as possible.
Lupus may also cause kidney disease, which can advance to kidney failure and need dialysis. You can help prevent these serious problems by seeking treatment at the first signs of kidney disease. These signs include:
Living with lupus
Most people with lupus can live normal lives. Treatment of lupus has improved, and people with the disease are living longer. But, it is still a chronic disease that can limit activities. Quality of life can suffer because of symptoms like fatigue and joint pain. Furthermore, some people do not respond to some treatments. Also, you may not be able to predict when lupus will flare. Such problems can lead to depression, anger, loss of hope or loss of the will to keep fighting.
Here are a couple of tips that may help you when living with lupus:
Rheumatologists have long been concerned that the female hormone estrogen or treatment with estrogen may cause or worsen lupus. Recent research showed that estrogen therapy can trigger some mild or moderate flares of lupus, but does not cause symptoms to get much worse. Yet, estrogen can raise the risk of blood clots. Thus, you should not take estrogen if your blood tests show antiphospholipid antibodies (meaning you already have a high risk of blood clots).
Who is Affected?
It can be a difficult disease to diagnose and a difficult disease to treat. It’s called lupus, and as many as 24,000 people in the United States are diagnosed with the disease each year.
May is National Lupus Awareness month, a time to think about lupus and the challenges it presents patients, researchers and health care professionals alike. Scientists today are working on many fronts to understand the genetic underpinnings of the disease and to develop new and more targeted therapies to treat it.
What is Lupus?
Lupus is a disease that can damage many parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels and brain. It is an autoimmune disease—an illness that occurs when the body mistakenly detects its own tissue as foreign and attacks itself, and can be fatal in some severe cases. While people of all races can have the disease, African American women have a three-times higher number of new cases than white, non-Hispanic women. African American women tend to develop the disease at a younger age than white, non-Hispanic women and to develop more serious and life-threatening complications. It is also more common in women of Hispanic, Asian and Native American descent.
The underlying cause of lupus is not fully known, and there are many types of the disease. The most common form, called systemic lupus erythematosus, commonly causes mouth sores, rash, fatigue, joint pain and swelling, as well as affecting the kidneys.
Lupus also is a chronic disease. “With treatment, the disease may quiet down, but it also may relapse eventually. Although it may be controlled with medications, once you get it, you will always have it,” explains Sarah Yim, M.D., a rheumatologist at the Food and Drug Administration (FDA). A person with lupus will have good periods and bad periods, she says, and symptoms can range from mild or moderate to severe.
Who is Affected?
Estimates vary on the number of lupus sufferers in the United States, ranging from approximately 300,000 to 1.5 million people. According to the American College of Rheumatology, ten times more women than men have lupus, and the disease often starts between the ages of 15 and 44.
What makes lupus so hard to diagnose? A lot of people can be called lupus sufferers but can all have different things wrong with their immune systems, Yim says. And many of the symptoms that can occur in someone with lupus are non-specific and can also occur in other diseases, making it hard to nail down the diagnosis.
Jonca Bull, M.D., director of FDA’s Office of Minority Health, says there is still an enormous need for better therapeutics, and that scientists may be on the cusp of more refined therapies that bring symptoms under control and bring about remission of the diseases that are associated with susceptibility to lupus or play a role in its development. FDA’s Office of Women’s Health has funded several studies related to lupus and other autoimmune diseases in recent years.
Treatment of lupus depends on the part of the body being affected by the disease, and how serious the problem. FDA approved the first drug to treat lupus, aspirin, in 1948 and later approved corticosteroids, such as prednisone, which suppress the immune system and reduce inflammation. In 1955, the agency approved the antimalarial drug Plaquenil (hydroxychloroquine) which helps to relieve some lupus symptoms such as fatigue, rashes, joint pain or mouth sores.
Part of what makes lupus research such a challenge is that the precise problem with the immune system is so different among patients, Yim says. New research is trying to zero in on what the best targets might be.
“Technologies have been developed in recent years that can make our medicines more targeted to address the specific molecule or molecules in the immune system that may be causing the problem,” Yim says. “Older medicines tend to suppress the whole immune system, which works, but it’s a little bit like shooting a fly with a cannonball, and can be associated with many undesirable side effects.”
FDA approved Benlysta—the first targeted therapy for lupus—in 2011. Benlysta is delivered directly into a vein. It is designed to target a protein called B-lymphocyte stimulator, which may reduce the impact of abnormal cells thought to be a factor in the development of lupus.
Yim says that Benlysta doesn’t work for everyone, and not enough research has been done yet to know if it will work in people with very severe lupus. But it works well for lupus patients with skin and joint involvement, she says.
Advances in the understanding and treatment of lupus over the last several decades have resulted in people with the disease living longer.
Despite these advances, however, there remain many people with lupus who need additional treatment options. FDA remains committed to working with researchers and drug developers to help make new treatments a reality.
Source: Food and Drug Administration & American College of Rheumatology
A female Aedes aegypti mosquito take flight as she leaves her host’s skin surface. Photo: James Gathany
About Zika Virus Disease
Zika virus disease (Zika) is a disease caused by the Zika virus, which is spread to people primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected. However, Zika virus infection during pregnancy can cause a serious birth defect called microcephaly, as well as other severe fetal brain defects. Once a person has been infected, he or she is likely to be protected from future infections.
Zika virus was first discovered in 1947 and is named after the Zika Forest in Uganda. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. Zika outbreaks have probably occurred in many locations. Before 2007, at least 14 cases of Zika had been documented, although other cases were likely to have occurred and were not reported. Because the symptoms of Zika are similar to those of many other diseases, many cases may not have been recognized.
In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil. On February 1, 2016, the World Health Organization (WHO) declared Zika virus a Public Health Emergency of International Concern (PHEIC). Local transmission has been reported in many other countries and territories. Zika virus will likely continue to spread to new areas.
A female Aedes aegypti mosquito in the process of acquiring a blood meal from her human host.
Photo: James Gathany
Areas with active mosquito-borne transmission of Zika virus
For Healthcare Providers
Pregnant Women and Women of Reproductive Age
Clinical Evaluation & Disease
Modes of Transmission
Zika virus is a single-stranded RNA virus of the Flaviviridae family, genus Flavivirus. Zika virus is transmitted to humans primarily through the bite of an infected Aedes species mosquito. The mosquito vectors typically breed in domestic water-holding containers; they are aggressive daytime biters and feed both indoors and outdoors near dwellings. Nonhuman and human primates are likely the main reservoirs of the virus, and anthroponotic (human-to-vector-to-human) transmission occurs during outbreaks.
Perinatal, in utero, and possible sexual and transfusion transmission events have also been reported. Zika virus RNA has been identified in asymptomatic blood donors during an ongoing outbreak.
Clinical Signs & Symptoms
Most people infected with Zika virus are asymptomatic. Characteristic clinical findings are acute onset of fever with maculopapular rash, arthralgia, or conjunctivitis. Other commonly reported symptoms include myalgia and headache. Clinical illness is usually mild with symptoms lasting for several days to a week. Severe disease requiring hospitalization is uncommon and case fatality is low. However, there have been cases of Guillain-Barre syndrome reported in patients following suspected Zika virus infection. Recently, CDC concluded that Zika virus infection during pregnancy is a cause of microcephaly and other severe fetal brain defects. Due to concerns of microcephaly caused by maternal Zika virus infection, fetuses and infants of women infected with Zika virus during pregnancy should be evaluated for possible congenital infection and neurologic abnormalities.
Diagnosis & Reporting
Based on the typical clinical features, the differential diagnosis for Zika virus infection is broad. In addition to dengue, other considerations include leptospirosis, malaria, rickettsia, group A streptococcus, rubella, measles, and parvovirus, enterovirus, adenovirus, and alphavirus infections (e.g., Chikungunya, Mayaro, Ross River, Barmah Forest, O’nyong-nyong, and Sindbis viruses).
Preliminary diagnosis is based on the patient’s clinical features, places and dates of travel, and activities. Laboratory diagnosis is generally accomplished by testing serum or plasma to detect virus, viral nucleic acid, or virus-specific immunoglobulin M and neutralizing antibodies.
As an arboviral disease, Zika virus is a nationally notifiable condition. Healthcare providers are encouraged to report suspected cases to their state or local health departments to facilitate diagnosis and mitigate the risk of local transmission. State or local health departments are encouraged to report laboratory-confirmed cases to CDC through ArboNET, the national surveillance system for arboviral disease..
No specific antiviral treatment is available for Zika virus disease. Treatment is generally supportive and can include rest, fluids, and use of analgesics and antipyretics. Because of similar geographic distribution and symptoms, patients with suspected Zika virus infections also should be evaluated and managed for possible dengue or chikungunya virus infection. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided until dengue can be ruled out to reduce the risk of hemorrhage. People infected with Zika, chikungunya, or dengue virus should be protected from further mosquito exposure during the first few days of illness to prevent other mosquitoes from becoming infected and reduce the risk of local transmission.
During the first week after onset of symptoms, Zika virus disease can often be diagnosed by performing reverse transcriptase-polymerase chain reaction (RT-PCR) on serum. Virus-specific IgM and neutralizing antibodies typically develop toward the end of the first week of illness; cross-reaction with related flaviviruses (e.g., dengue and yellow fever viruses) is common and may be difficult to discern. Plaque-reduction neutralization testing can be performed to measure virus-specific neutralizing antibodies and discriminate between cross-reacting antibodies in primary flavivirus infections.
Source: Centers for Disease Control and Prevention