Sign of the Wolf

Only a few days before she was to marry her college sweetheart, Joan, 23, received shocking news. Her Wasserman test had turned out positive, indicating that she might have syphilis. Refusing to believe those results, she promptly demanded and got another examination--which confirmed that she did not have syphilis. The "false positive" had been caused by a more serious ailment: the baffling--and as yet incurable--disease of systemic lupus erythematosus (SLE), which afflicts perhaps half a million people in the U.S.

Striking predominantly women in their childbearing years, lupus erythematosus ("red wolf disease") was given its bizarre name by 19th century doctors who thought that its characteristic reddish rash resembled a wolfs bite. Now physicians know that discolored skin is only one symptom of a far more pervasive ailment. Like rheumatoid arthritis, SLE is one of the so-called autoimmune diseases, caused by the body literally waging war on itself.

At first the damage may be relatively minor: a slight fever, fatigue and the reddish rash, which often takes a "butterfly" shape across the nose and cheeks. But as SLE progresses, severe inflammation may occur in the joints, hair fall out, and sores appear in the mouth, nose, throat and vagina. Unless lupus is somehow contained--or undergoes spontaneous remission--the heart and blood vessels may be damaged. The kidneys could begin to fail, and even the central nervous system can be affected.

What triggers this immunological mayhem remains one of medicine's major puzzles. Some doctors suspect that a tendency toward lupus may be inherited. At the University of California in San Francisco, researchers found that in mice, at least, lupus appeared to be aggravated by female hormones and controlled by male hormones. Other scientists think that the disease may be triggered by viruses. Possibly all these elements may be involved in lupus. Says N.Y.U.'s Dr. Gerald Weissmann: "If I knew what causes lupus, I'd be in Stockholm."

Decent Lives. Still, there has been progress in fighting the disease. Says Dr. Morris Ziff, of the University of Texas Health Science Center in Dallas: "Most lupus victims can now expect to live reasonably decent lives." One reason: improved blood tests are letting doctors diagnose lupus earlier than ever. (As in Joan's case, the Wasserman test often turns up lupus quite accidentally.) Another reason: prompt detection has been accompanied by introduction of more effective treatments.

During the months and even years when the disease is in a mild stage, the patient may need only aspirin--or no treatment at all. But when lupus flares up, doctors resort to more powerful weapons. Corticosteroids are commonly used to control inflammations. Skin rashes can be reduced by antimalarial drugs, and even the immune system's rampaging white cells can be brought under control by some of the same potent drugs used against cancer cells.

Because effects of these medicines are sometimes severe, doctors must use them judiciously. Patients too must help; stress, overexertion and strong sunlight all can cause a sharp relapse. As Dr. Sheldon Blau and Dodi Schultz explain in their new book Lupus (Doubleday; $5.95): "The patient and doctor must function as a partnership--analogous, perhaps, to a police team on foot patrol, never knowing from what source trouble may appear, but constantly prepared to cope with any eventuality."

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