Medical Moment: How lupus can affect the heart

Published: Nov. 2, 2022 at 5:31 PM EDT
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(WNDU) - Lupus is a chronic disease that mainly affects the skin, joints, kidneys, and blood cells.

But it can also affect the heart.

Now, there’s new research that could help detect these heart problems early.

“I’ve noticed weight gain, fatigue, joint pain,” Diana Yeauger Espinoza recalled. “It wasn’t until I got to the hospital that I got my diagnosis for lupus.”

Younger women in their mid-thirties or forties with lupus are more than 50 times more likely to have a heart attack than women of similar age who don’t have lupus.

“Lupus is much more common in women than men, about nine to one,” Brad H. Rovin, a professor of medicine at The Ohio State University Wexner Medical Center.

Researchers at the University of Houston say a comprehensive metabolic screen from the blood can identify metabolism that might lead to future plaque build up in the heart.

Heart problems commonly associated with lupus include inflammation of the sack that lines the heart, valve abnormalities, rhythm disorders such as arrhythmias, inflammation of the muscular tissue, and accelerated arterial plaque build up.

Doctors say controlling active lupus and preventing flare-ups are the best steps in preventing and managing heart problems.

“The quicker you can get to the patient and treat them, the more effective the medications are to decrease the inflammation, turn off the inflammatory systems,” Dr. Rovin explained.

Early identification in these high-risk lupus patients can launch preventive measures during the early stages of the disease.

Promising results from a small study led by rheumatologist Georg Schett at the University of Erlangen-Nuremberg in Germany may have discovered a way to reset the immune system for the 1 in 1,000 people affected by Lupus.

Five patients who were seriously ill with lupus have seen their disease go into remission with one single infusion of modified immune cells. Using the same type of successful cell-based therapies called chimeric antigen receptor (CAR-T) to treat blood cancers, researchers are now testing the approach on lupus. CAR-T therapies work by taking a patient’s immune cells and engineering them to find and destroy rogue cells, such as cancer or other immune cells, and then placed back into the body to do their work.

The goal for lupus is for the modified cells to hunt down and destroy the faulty B cells, specifically the CD19, which pumps out autoantibodies that attack the body’s own cells.

Results from a blood test showed the one-time therapy wiped out the misguided B cells causing disease-causing autoantibodies to be below detectable levels.

It’s too early to call the patients cured, but all five (four women and one man) for the last 5 to 17 months have been in remission and have not relapsed even with a resurgence of B cells after treatment. It will now be tested in larger studies to check for known side effects of the CAR-T therapies and whether it will work for some or all patients and will remission last.

Because these therapies are tailored for each patient and the manufacturing capabilities of making modified immune cells, it might only be feasible to use as a last resort for severe lupus patients who don’t respond to other drugs.