Scleroderma, a rare and progressive condition, is caused by the immune system mistakenly attacking healthy tissues, leading to damage and scarring of the skin and possibly other organs.
As scleroderma is an immune system disorder, these patients may have other autoimmune diseases, such as systemic lupus erythematosus, or lupus. In fact, lupus affects an estimated 20 percent of all scleroderma patients.
Such related conditions are often called overlapping or crossover diseases.
Symptoms
Many lupus symptoms overlap with those of scleroderma, complicating an accurate diagnosis.
The most common symptoms associated with lupus are joint and muscle pain, along with extreme tiredness and weakness. Others make up a long list: sensitivity to light, headaches, migraines, seizures, hair loss, flu-like symptoms, skin rashes, kidney problems, and mouth or nose ulcers.
Overlapping symptoms common to lupus and scleroderma include:
- Raynaud’s phenomenon, characterized by poor circulation and painfully cold fingers and toes.
- Esophageal dysfunction, or problems with the digestive system.
- Sjögren’s syndrome, which affects the fluid-producing glands, like tear and salivary glands.
Diagnosis
Lupus and scleroderma can be difficult to differentiate in a diagnosis, and patients may initially be misdiagnosed with one or the other condition. Diagnosis normally involves a physical exam, an account of the patient’s medical history, and a description of symptoms.
If a patient has symptoms distinct to each condition, such as the hardened patches of skin seen in scleroderma and the light sensitivity seen in lupus, this may indicate both conditions are present in that person.
Various blood tests are often used to support a diagnosis, because they can indicate the presence of certain antibodies or immune proteins more common to one condition or the other. For example, the antibodies anti-dsDNA, anti-smith, anti-Ro/SSB, and anti-La/SSB are more common to lupus than scleroderma.
Lupus can also cause blood cell numbers to drop, and this change can be measured though a complete blood count (CBC) test.
Treatment
There is currently no cure for either lupus or scleroderma, but therapies help to manage both conditions. Patients may react differently to therapies, and it may take time to determine a combination that works for each individual.
Anti-inflammatory medicines, such as prednisone, can help with the joint and muscle pain that both lupus and scleroderma may cause.
Anti-malarial drugs, such as Plaquenil (hydroxychloroquine), is often used to manage lupus and can also be effective in scleroderma. Plaquenil is thought to interfere with communication between immune cells, which can suppress the damaging effect of an overly active immune response without raising a patient’s risk of susceptibility to infections. The medicine can also reduce many of the symptoms associated with lupus, such as rashes and fatigue, and protect against damage from UV light. Lupus may also be treated with other anti-malarial therapies, including Aralen Phosphate (chloroquine) or Atabrine (quinacrine, or mepacrine).
Immune suppressant medications, such as methotrexate, Imuran (azathioprine), or cyclophosphamide may also be effective in treating both lupus and scleroderma.
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