Question: I am 50 years old and have problems with water retention mostly in my ankles and stomach area. I am 5'7'', weigh 329 and I have lupus, which runs in my family. I take a 25 mg HTZ fluid pill and Lotrel for high blood pressure. Fluid builds up when my lupus flares and no one is able to help me. Can you help me understand Lupus?
Dr. Hibberd's Answer:
Fluid retention (edema) can have many causes. Often, flares of lupus (correctly called SLE or systemic lupus erythematosis) are treated with prednisone-like medications and immune suppressants which have fluid retention as a prominent side effect. In addition, some patients have poor circulation as a result of poor lung or heart function, while others have physical factors such as obesity that are major risks for clots and sluggish venous return.
Intermittent swelling of your stomach and legs suggests you should have a cardiology (heart) and pulmonary (lung) evaluation promptly. Simple, non-invasive studies such as a 2D cardiac ultrasound, EKG, Chest x-ray and pulmonary function studies will help your doctors evaluate these systems, and hopefully help you avoid worsening problems during lupus flares.
You are very young and extremely overweight. Ask your doctors for help in reducing your weight, and be sure your lupus is being aggressively controlled. Laparoscopic gastric banding and other procedures designed to reduce gastric (stomach) capacity, although not free of side effects, have become very popular for patients with extreme obesity who have failed other more conservative measures.
Unfortunately, your lupus may disqualify you from this procedure. Even if well-controlled, lupus places you at increased risk of post-procedure complications. Steroid and immune suppressant therapy will also place you at increased risk during and following the surgical procedure, making the potential benefits of this procedure potentially pale against the possible complications of surgery.
Lupus is a serious multi-system autoimmune (antibodies directed against your own tissues) inflammatory condition. It is more common among young women of child-bearing age, and is believed to be caused by unknown environmental triggers. 70-90 percent of lupus victims are women. It is more common in black women, but lupus can occur at any age, even in newborns, infants and children.
Lupus often affects the renal (kidney) system as well as joints, skin, and blood cell production. Nervous system (brain, spinal cord, and nerves), heart, and lung complications are seen often associated with inflammation of tissue and blood vessels and an increased tendency to thrombosis (clots), especially in those with anti-phospholipid antibodies.
Lupus and its autoimmune reactions usually run in families. Some drugs (such as procainamide and hydralazine) may produce a lupus-like condition that is reversed upon drug discontinuance.
There are many patients with lupus who live very productive lives with reduced flares thanks to newer medications. The American College of Rheumatology defines criteria for the classification of SLE intended to help guide physician treatment interventions. The Lupus Foundation of America is an excellent source of education and support for patients and can be contacted at lupus.org. Most patients with lupus consult rheumatologists who work in conjunction with the primary physician (family physician or internist) to guide treatment recommendations.
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