A recently aired episode of “Keeping Up with the Kardashians” revealed that Kim Kardashian West had tested positive for lupus and rheumatoid arthritis (RA) antibodies, putting a spotlight on these autoimmune disease.
“I’ve been feeling so tired, so nauseous and my hands are really getting swollen,” Kardashian said on the show. “I feel like I literally am falling apart. My hands are numb.”
While little has been formally unveiled about Kardashian’s specific case, she did share that she is on medication for the symptoms and that future episodes would reveal more.
Her plight brings awareness to what people may want to know about both conditions and the difficulty in getting a clear diagnosis
Suspicious symptoms
Symptoms of RA and lupus can overlap and occur at different times, making both ailments hard to diagnose.
Both are autoimmune diseases and it can take years to get a clear diagnosis.
One clear symptom of lupus is something called the malar rash.
It’s a rash on the nose spreading outward on the cheeks that appears like a butterfly — a telltale sign of lupus, explained Dr. Saakshi Khattri, an assistant professor, board-certified rheumatologist and dermatologist at the Icahn School of Medicine at Mount Sinai in New York.
Other symptoms of lupus include discoid lesions that can appear like a scaly rash on the head and neck, photosensitivity, mouth ulcers, hair loss, and fatigue.
Less common signs can include swelling of the face, hands, or legs; joint swelling or pain; and fluid around the heart or lungs that causes breathing issues or chest pain.
“Lupus is a great imitator,” Khattri said. It can affect different organ systems so it presents differently person to person. A patient is formally diagnosed only when certain criteria are met. Sometimes manifestations don’t happen all at once and can be separated by time. This is what makes it so difficult to diagnose.”
“Lupus has a wide range of symptoms that can come and go over time. It can damage any organ or tissue, from the skin or joints to the heart or kidneys,” added Dr. Sara Tedeschi, a rheumatologist at Brigham and Women’s Hospital in Boston and member of the Lupus Foundation of America’s Medical-Scientific Advisory Council.
“On average it takes a person 6 years to be diagnosed with lupus from the time they first notice their symptoms,” she added.
Alternately symptoms of RA can include swollen joints, joint stiffness typically worse in the morning or after activity, fatigue, fever, and appetite loss.
Testing options
Because symptoms of the diseases can be similar, doctors may test a patient to see if he or she has lupus or RA. Testing for both usually happens if a patient complains of joint pain, because it is seen in both conditions among others, Khattri said.
The antinuclear antibody (ANA) test is most commonly used as an initial test if a doctor suspects some sort of autoimmune condition, but it is not specifically used to diagnose lupus, Tedeschi said.
“Lab tests alone are not enough for diagnosis of lupus,” Khattri explained. Clinical features are also important in a diagnosis.
The ANA test will come up positive in 97 percent or more lupus patients. But a positive ANA test alone is not enough to diagnose the disease, Khattri added.
The meaning of a positive test result depends on the clinical scenario, Tedeschi explained.
“In a patient with no symptoms to suggest lupus, or with a few non-specific symptoms like fatigue, a positive ANA test can be a false positive,” she pointed out. “Other autoimmune diseases, or a family history of autoimmune disease, can also cause a positive ANA. The level of the positive test also matters.”
“The clinical scenario matters quite a lot when interpreting these results, as does the level of the test result. It is possible that a patient could have a low positive ANA and a positive rheumatoid factor, but clinically not have symptoms or signs of lupus or rheumatoid arthritis,” she said.
More lupus, RA tests
Further antibody testing, such as the anti-Sm and anti-dsDNA tests, can give more insight into pinpointing lupus.
To test for RA, the rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCP) can be used. X-rays can show changes in RA over time as well, and may also be used to draw comparisons of damage, Khattri said.
The anti-CCP test is more specific for RA compared to the RF test, Tedeschi noted. “A positive rheumatoid factor can be seen in older adults who do not have rheumatoid arthritis, and it can also be positive in patients with other medical conditions,” she said.
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