Report Calls for Counseling Guidelines for Treating Transgender People

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Health Tip: Treating Osteoarthritis

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Strides Made in Diagnosing, Treating Lupus

HealthDay – 1 hr 34 mins ago THURSDAY, May 10 (HealthDay News) -- Sometimes it takes years for people to get diagnosed with lupus. That wasn't the case for Marisa Zeppieri-Caruana, who had so many of the classic systemic lupus erythematosus symptoms -- such as a butterfly-shaped rash on her face, a daily fever and achy joints -- that her doctor knew right away that the 23-year-old had the illness.

Since then, Zeppieri-Caruana, now 34, has been hospitalized 30 times and has had four mini-strokes along with numerous other problems related to her lupus.

Most people who have lupus go through periods where they have active disease (flares) and periods where they don't have any symptoms (remission). Unfortunately, Zeppieri-Caruana said she's never had a time where she's been totally in remission.

"An average day for me includes fatigue and fever. It's really hard to try to put weight on, and I usually don't feel like doing anything. I have to take a nap every day," she explained.

"It's almost like I'm carrying a backpack all day long. Sometimes it's only 10 pounds, but sometimes it's much more. So even if I'm doing little things, it's like I'm doing them with an elephant on my back. It's exhausting carrying that extra load all the time," she said.

May 10 is World Lupus Day, a day designed to heighten awareness of this chronic autoimmune disease. About 1.5 million Americans have some form of lupus and worldwide that number is estimated to be about 5 million, according to the Lupus Foundation of America.

Lupus tends to strike women far more often than men. "The female-to-male ratio is nine to one and, in general, lupus is diagnosed in women of childbearing age," according to Dr. Howard R. Smith, a rheumatologist at the Cleveland Clinic, in Ohio.

However, progress is being made.

For example, many people are getting diagnosed sooner than they did in years past, said Dr. Kenneth Kalunian, a member of the Lupus Foundation of America's Medical-Scientific Advisory Council, and professor of clinical medicine at the University of California, San Diego School of Medicine. "Things are definitely improving in getting a diagnosis, but there's still a lag time in people with less specific symptoms. But it's markedly increased from just 10 years ago," he said.

Another expert explained why that time lapse can occur.

"Lupus can take a long time to recognize. It mimics many other diseases, and it's important to make sure a patient doesn't have an infection or a malignancy," said Dr. Michelene Hearth-Holmes, an assistant professor of internal medicine and rheumatology at the University of Nebraska Medical Center, in Omaha.

Most people with lupus will be fatigued, they may have a rash on their face across the bridge of the nose and cheeks, and many will have arthritis symptoms and frequent fevers. "Lupus can be a disease that affects patients from head to toe," Smith said. Areas it can affect include the skin, joints, kidneys, heart and blood vessels.

Along with getting a quick diagnosis, another tricky aspect of lupus is that it varies from person to person. "No two cases of lupus are alike. Each patient has to be treated as an individual. Symptoms can range from mild to life-threatening," Hearth-Holmes said.

There are a number of medications that can be used to treat lupus. Aspirin and other pain-relieving medications can help control some of the symptoms, as can corticosteroids. Another commonly recommended treatment is a drug called hydroxychloroquine (brand name Plaquenil) that was originally developed as a drug to combat malaria.

The most recent medication approved specifically for moderate to severe lupus with no kidney involvement is called belimumab (brand name Benlysta). This injectable medication modifies how the immune system works.

There are a number of other medications being developed or studied in trials that will alter the way the immune system works, according to the experts, and the hope is that newer drugs will be more effective and have fewer side effects.

"It's a very promising time in lupus research. It's reminiscent of where rheumatoid arthritis was 10 to 15 years ago when many patients ended up in wheelchairs. I don't see many rheumatoid arthritis patients in wheelchairs anymore," Kalunian said.

While the researchers are still working on better medications, there are some steps patients can take on their own. For example, all three doctors and Zeppieri-Caruana said that anyone with lupus should stay out of the sun as much as possible. And, if patients have to be outdoors, they should cover up with clothing, sunscreen, a hat and sunglasses. Sun, in addition to aggravating a lupus rash, can actually activate the disease in the rest of the body, according to Kalunian.

Smith said it's crucial that people don't smoke if they have lupus. "Smoking is terrible for lupus patients because there can be blood-vessel involvement."

Zeppieri-Caruana said she's noticed that what she eats makes a big difference in how she feels. She said red meat and fried foods, in particular, can aggravate her lupus. Smith said it's important to eat heart-healthy foods, such as fruits, vegetables and whole grains, because heart disease is increasingly being recognized as a risk for people with lupus.

It's also important to rest when needed. But, Hearth-Holmes said, this really varies from person to person. She said some people can work full time, while others find it exhausting. Her advice? "Limit yourself only as much as you want to limit."

Exercise can also help people with lupus stay in shape and stay more flexible. But, again, this will depend on the severity of the disease. Smith advised that even those with severe lupus should try to participate in some sort of activity. "Inactivity leads to problems on its own. Bones become thinner and it gets harder for people with swollen joints to move them," he said.

Zeppieri-Caruana also recommended joining a support group and seeing a therapist to talk about living with lupus. She said there are online groups available, which is very helpful when you're too tired to go out, but still need the support.

More information

Learn more about lupus and World Lupus Day from WorldLupusDay.org.

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Treating childhood obesity: A family affair

ScienceDaily (May 1, 2012) — With nearly one-third of American children being overweight or obese, doctors agree that there is an acute need for more effective treatments. In many weight management programs, the dropout rate can be as high as 73 percent, and even in successful programs, the benefits are usually short term.

See Also:Health & MedicineStaying HealthyObesityChildren's HealthDiet and Weight LossWorkplace HealthFitnessLiving WellReferencePediatricsOverweightDiabetes mellitus type 2Body mass index

Although family-based approaches to pediatric obesity are considered the gold standard of treatment, theories of the family and how it functions have not been incorporated into effective interventions, according to a study published in the May issue of the International Journal of Obesity by researchers at Wake Forest Baptist Medical Center.

"The field of family studies provides an innovative approach to the difficult problem of pediatric obesity, building on the long-established approach of family-based treatment," said Joseph Skelton, M.D., assistant professor of pediatrics and director of the Brenner FIT (Families in Training) Program at Wake Forest Baptist, and lead author of the study. Skelton and his research team reviewed medical literature published between 1990 and 2011 to identify the use of prominent family theories in pediatric obesity research. Of the 76 manuscripts found, 13 were selected for the study.

Wake Forest Baptist researchers found limited use of family theories in the study of pediatric obesity, particularly in weight management treatments. Family behavioral theories can provide valuable insight into the complexities of families, and increased use of these theories in both research and practice may help in the development of more effective treatments for childhood obesity, the study found.

"Traditionally doctors looked at the patient as the one in the family to focus on, but now we have to look at the entire family as the patient," Skelton said.

"One of the problems we found was that there wasn't even a clear definition of family in the literature. A two-parent household with a stay-at-home mother and working father is no longer the norm. Inability to define the family makes it difficult to apply a straightforward model of family function to child health and weight management."

In the clinic setting, families are often represented by a child and a parent, typically the mother. However, this often does not accurately reflect family complexity and it doesn't define which family members should be included in treatment, Skelton said. A common theme in the field of family studies is that families are a system, made up of interdependent units. Intervening with one unit, such as a mother and a child, will influence other units. These interpersonal relationships influence the health behaviors of the child and the family as a whole, according to the study.

"The challenge is to find ways to incorporate the entire family in the process, while allowing for different schedules and different age kids with different health needs," Skelton said. "If we don't find more effective treatments and this epidemic continues, these children will likely go on to become obese adults, resulting in an entire generation with lower life expectancies than their parents' generation."

Skelton and his team at Brenner FIT have begun incorporating theories of the family into their research and in their treatment approach, and are finding ways to engage more members of the family in treatment.

Funding for the study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Duke Endowment and the Kate B. Reynolds Charitable Foundation.

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