the prairie doc

Diagnosing lupus — a wolf in sheep’s clothing


Imagine a condition with symptoms that present differently in each person who has it, and no currently approved lab test can definitively confirm the diagnosis. Imagine that the symptoms can flare up and then mysteriously disappear, including fatigue, low grade fevers, joint pain and mouth sores. All these symptoms overlap with multiple other conditions further complicating a diagnosis. Imagine that the best available method for diagnosing this ailment is a manual checklist of eleven criteria, and if the patient suffers from at least four, they receive a diagnosis on a scale of definite, probable or possible.

What if I told you this condition is caused by an attack on the body by its own immune system, and the main way to treat this is by suppressing the immune system we each depend upon to help protect our bodies from infection. The course of this illness can range from mild to rapidly progressing to organ failure and death. This condition is real and has a most appropriate name which means “the wolf” in Latin. The condition is systemic lupus erythematosus (SLE), a condition which evades diagnosis and is difficult to treat.

Lupus mainly affects women between the ages of 15 and 40, particularly women of color. For many busy young women with lupus, symptoms are often brushed off by family, friends, and unfortunately, sometimes by health care providers who may view the patient as being “tired” or “over worked.” Routine wellness lab tests, which serve as an alert system for other illnesses, provide no indication of lupus. Patients who persist and find someone to further investigate their symptoms may be misdiagnosed with a myriad of other conditions sometimes resulting in unnecessary medications, treatments and further suffering.

Work is underway to better understand lupus. The trigger that causes the immune system to start attacking itself is not known, but scientists suspect it involves a combination of genetic and environmental factors.

Research and awareness are making a difference. In the 1950s, the 5-year and 10-year survival of SLE patients was less than 50 percent. Since then, that number has improved to over 90 percent. This increase in survival rate stems from improvements in our ability to diagnosis lupus earlier and to provide better treatments once diagnosed. But we must do better. Early diagnosis of lupus requires patients and health care providers working together to persist in finding this “wolf in sheep’s clothing.”

If you or a loved one has a concern about lupus or other autoimmune conditions, talk with your doctor and see if a consultation with a rheumatologist would be beneficial.

Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at and on Facebook featuring On Call with the Prairie Doc®, a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.


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