Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare and what matters to you. And now here's our host, Dr. David Den .

Speaker 2: 0:18

Hey everybody, it's Dr. David Hilden , your host of the podcast. And welcome to this episode where we're gonna talk about lupus. Many of us have heard about lupus. You maybe even even know somebody who's had it, but you really know what it is, what causes it, what can be done about it. So, joining me is somebody who knows a great deal about the subject, Dr. Awad Nasser . He is the division director of rheumatology at Hennepin Healthcare in downtown Minneapolis. Rahad , welcome.

Speaker 3: 0:44

Thank you, David. Great to see you again.

Speaker 2: 0:46

Yep . And Rahad Hass been on the show before. He is a good friend of mine. I've known him for many years, and he is , uh, I would call the best rheumatologist I know. So , uh, I've tapped him to be on the show again today. Start us off, Dr . Nasser. What is lupus? What branch of medicine does it fit into?

Speaker 3: 1:01

So, lupus, it's an autoimmune disease that affects multiple systems in the body. And given it's an autoimmune disease, it falls under the rheumatologic , uh, diseases. So patients with lupus usually would see care with rheumatologist, and ultimately a lot of their care gets through a rheumatologist.

Speaker 2: 1:18

So that's what you do for a living, right ? You do rheumatology. Back in the day, like a hundred years ago, people talked about rheumatism, this, that, and the other thing. It's a vastly different field. Now you do things like arthritis. Correct.

Speaker 3: 1:30

So we do things like arthritis, but also autoimmune diseases. We do see patients with arthritis due to wear and tear and biomechanics, but also we see patients with arthritis due to inflammation, which can occur in multiple diseases like rheumatoid arthritis and lupus.

Speaker 2: 1:44

So that's what we're gonna, that's kind of to get us grounded. Now, tell us about lupus itself. What is it? So

Speaker 3: 1:49

Lupus , uh, as I said, it's autoimmune and it affects multiple systems in the body. Uh, for example, it affects the skin, the joints, the kidneys, the heart, the lungs, and sometimes our nervous system and on bone marrow. Um , now most patients, they present usually with skin and joint symptoms. And then we do some additional testing and sometimes we find it involved internal organs and sometimes it doesn't. So

Speaker 2: 2:15

You named just about everything. Yeah . <laugh> . So I'm gonna , I'm gonna parse out a word or two outta that autoimmune. What does that mean?

Speaker 3: 2:23

Yeah , so autoimmunity. So you know, when a patient asks me what is an autoimmune disease, I say, okay, when a patient gets an autoimmune disease, they usually have a genetic predisposition. So we have the genes for the disease, and then we get a stressor on our body that triggers the genes. The stressor could be ranging from an infection, a medication, pregnancy, stress, trauma, anything that stresses the body can trigger these genes. Now, when these genes are triggered, they produce substances and proteins that confuse the immune system. So immune system goes up in the body, confused and starts to attack our own body, which is not what it was designed to do. Immune system was designed to go up in the , in the setting of infections, to fight infections, but it's because it's confused. It goes up in the body and then it starts to attack our own body. Now, wherever it goes in the body, we call the disease. So if it goes to our skin and cause this rash on the face and sores in our mouth and arthritis and maybe sometimes the kidneys, we call it lupus. If it only goes to the joints and cause inflammation, certain joints, we call it rheumatoid arthritis. If it goes to our bowels, we call it Crohn's disease, et cetera . So the name of the disease is where the immune system is confused and active and causing inflammation and damage.

Speaker 2: 3:29

That was really helpful , um, because, you know, I know lupus as something that that's kind of all over the place, but it's your own body somehow a genetic disposition that got triggered to attack your own body in wherever it happens. That's really , that was a really good description. Thank you. So before we get onto the symptoms about what does it look like on a real human body, I wanna talk about the origins of the , of what it's called. It's called lupus, but it's real name is longer than that. It's real name is SLE, systemic lupus. Erythema ptosis. That's for all you trivia nerds out there. You can thank me next time you win pub trivia. But we normally shorten all that to lupus. What the heck? What is , where does that word come from?

Speaker 3: 4:08

Yeah, so lupus is a Latin word and what it means is wolf. And it was used to describe lupus in the skin because it resembled a wolf bite. So now these days we call it discoid lupus, that that type of lesion. But it basically goes , it resembles a wolf bite. They called it lupus.

Speaker 2: 4:25

Historically, that is an awfully creative naming for an A disease. Okay. So that's the origins of SLE, otherwise known as lupus. Now, shift gears. What does it look like in a human body? What are the symptoms?

Speaker 3: 4:36

Yes . So as I said, most patients they present with skin and joint disease. So they present with pain and swelling in the joints, stiffness in the joints, usually the hands of the feet , uh, the elbows, the shoulders in asymmetric fashion in both sides of the body. Patients present with a rash on the face. Butterfly rash we call it. That was triggered by sun because that

Speaker 2: 4:53

Looks like a butterfly.

Speaker 3: 4:53

It looks like a butterfly on the face. Exactly. And it's usually triggered by sun exposure. So we call it photo sensitive rash. Also, they can get , um, as we mentioned, disco lupus, which are like ulcers on the skin that you see on the face. And the upper extremities, mouth sores, sores in the nose, hair loss, chest pain with breathing. Usually those are the symptoms that triggers the patient. Something's happening in my body. I need to see primary care or rheumatologist figure this out. Yeah. Be

Speaker 2: 5:19

Before you get onto other things in the body. A lot of people listening right now, I bet I'm thinking, well , my joints hurt . Do I have lupus? How do you know if it's something that that could be part of this larger disease process other than, you know , I got , I got osteoarthritis.

Speaker 3: 5:34

Right. So two th great question. So two things. One, the arthritis is inflammatory. So patients should, will feel the pain at rest. So the , the hands and are are for example, swollen, painful at rest without even using them. And it's very hard to do fists. And then they're stiff in the morning for like 30 minutes, an hour. So if they're very stiff in their joints and they're swelling and pain to the extent where they can't use their joints even for simple movements, then this is significant arthritis. And the second part, the arthritis has to be with other symptoms that I mentioned. Skin involvement, rashes, mouth sores, hair loss, chest pain. 'cause sometimes if it's only arthritis, it could be just rheumatoid arthritis, for

Speaker 2: 6:10

Example. Mm-hmm <affirmative> . Which is another inflammatory arthritis. Another

Speaker 3: 6:13

Inflammatory arthritis. Correct .

Speaker 2: 6:14

Which leads to the stiff hands. Correct. So stiff hands joints worse in the morning. Right. And some of these other symptoms. Correct. What other organs can it affect?

Speaker 3: 6:23

Yeah , the main internal organ that can affect is are the kidneys. So , uh, a lot of patients have decreased kidney function, high blood pressure, and then sometimes they see a nephrologist. And the nephrologist recommend a kidney biopsy to figure out what's going on. They have lupus in the kidneys. The other organ that can involve is the nervous system, whether it's our peripheral nerve , the nerves in our body or the brain. And uh , some patients can present it . It varies from simple headaches to like seizures and confusion to weakness in certain parts of the body. Uh, and then also the lungs and the heart. A lot of patients can have inflammation around the lungs, tissue and around the heart tissue. They can get chest pains due to inflammation in the heart and the lungs. And rarely, sometimes they can involve the lungs inside the lungs so they can present with cough, shortness of breath. So basically it can involve the lung, the heart, the kidneys, and the nervous system. And finally the bone marrow. So bone marrow, yeah, inflammation, the bone marrow. So we have less cell counts, less white blood cells or less red blood cells. So we have less white blood cells. They can have more infection or more even allergies. Or if they have less red blood cells , they're anemic, they're weak. Uh , the patients feel weakness, fatigue, which is also part of the symptoms. Fatigue , um, fatigue, brain fog, as I mentioned , uh, I didn't mention that, but brain fog also is part of the nervous system. This

Speaker 2: 7:38

Isn't fair, you know , um, you know, I do know some dear friends of mine who have lupus and I have a lot of patients with 'em. But this affects so many organs.

Speaker 3: 7:48

Absolutely. It's our , one of our most challenging autoimmune disease. A lot of our immune pathways get affected in lupus. So it's like where it goes everywhere, it , it's, it's immune your

Speaker 2: 7:58

Skin and your bone marrow. Those are not exactly related places in your body. Right .

Speaker 3: 8:01

It's an immune system. Mayhem, if you want. It is mayhem from an immunologist perspective, I mean

Speaker 2: 8:05

The timeframe. Yes. Is it a quick thing or a sudden thing?

Speaker 3: 8:09

You most patients, it's a chronic thing. It's a slow thing. So symptoms develop over month or years. But sometimes some patients, when we see them in the hospital, particularly here at HCMC, sometimes they're at this , they present as sick. For example, they come with shortness of breath, coughing up really

Speaker 2: 8:25

Late in the disease, late in the disease . Or advanced problems. Yeah ,

Speaker 3: 8:27

Disease . Correct. Or their kidney function is really reduced. So a lot of it's usually slow, but sometimes it comes sudden . Now, interestingly, lupus , um, I'll mention it now since we're talking about how patients present, it's usually more in women than men. Um , so in women it's usually presents with every, with the , the symptoms we mentioned, you know, skin joints and the kidneys. In men, it interestingly presents usually in internal organs. Ah . So a lot of

Speaker 2: 8:52

Times without the skin stuff,

Speaker 3: 8:53

Without the skin stuff, a lot of times, times they're in the kidney clinic, they biopsy , uh, you know, the kidney and they find lupus nephritis and oh , you have lupus and then we see them. They could be just the kidneys or they could have a little bit of symptoms. So there's also a difference in how it presents between a gender , uh, in that sense. And

Speaker 2: 9:09

It's younger people too, right?

Speaker 3: 9:11

It's young, correct. It's usually childbearing age, you know, 18 to 44. But yes, classically patients present mostly 'cause they have joint pain and rashes and mouth sores. But as I said, sometimes it presents in the internal organ without the other symptoms, which makes it more confusing and challenging to diagnose. How

Speaker 2: 9:30

Common is lupus?

Speaker 3: 9:32

Yeah , so lupus , uh, globally, it's about , uh, 44 persons per hundred thousand in the United States, about 72 per hundred thousand. The CDC estimates about 204,000 people in the US uh, who have lupus in 2024. So

Speaker 2: 9:45

It's not particularly common, but that's not rare. Correct.

Speaker 3: 9:48

Um, those

Speaker 2: 9:49

Are two different things. Correct. Some diseases are very, very rare. You might see 'em once in your career, whereas you see lupus all the time. Correct.

Speaker 3: 9:57

In rheumatology at , especially in our, in our hospital safety net hospital, we see a lot of lupus patients in our clinic right

Speaker 2: 10:03

Now . Yeah . That's not in the general population. That's not

Speaker 3: 10:05

General population. But , but , but

Speaker 2: 10:06

It is something that is not, it's not like this thing you're never gonna see in your lifetime. It's uh , it's not common, but it's actually, it's

Speaker 3: 10:13

Around. I agree.

Speaker 2: 10:14

Um, what about family history? Does that matter?

Speaker 3: 10:16

Yes. Family history matters. If patients have family history of lupus , uh, they're at higher risk of getting , uh, lupus for sure. So

Speaker 2: 10:24

Let's talk about somebody coming in to see you. They're in your rheumatology clinic. Maybe they've had some , uh, these symptoms we've been talking about. They saw their primary care person and they said, this sounds like something more than just a little, you know , joint pain. I'm gonna send you to the rheumatologist. When they get to see you, how do you diagnose it?

Speaker 3: 10:41

So one, we take a lot of history like as we were talking, so we have to ask a lot of questions because there's so many symptoms are involved. So a lot of good history taking. And after we do a very thorough history taking, then we examine to see do we feel swelling in the joints? Do we see a mouth sore in the upper mouth? The classic lupus mouth. We measure, we examine the skin, do we see the classic rash in the skin? We ma we look at thecal. So a very thorough physical exam. And then blood and urine tests , uh, because there are certain blood tests that are treated with lupus,

Speaker 2: 11:13

But they're not fully diagnostic. Are they? Is there one blood test ? Correct . Can , isn't there just one blood test? There's one blood test. Get it and tell me if I have it or not. There's not, there's

Speaker 3: 11:21

Not, there's highly sensitive tests. Okay. But to diagnose lupus and in general, honestly to diagnose rheumatic disease, you have to have two things. You have to have serologies or blood tests. Yes. And you have to have the physical exam and the history. It's the combination of the findings by history taking and physical exam and the test that give you the diagnosis.

Speaker 2: 11:40

So it's not just a blood test that any old doctor can do. You need the blood tests . You need the physical exam . And you need a smart rheumatologist

Speaker 3: 11:46

Basically. Yes. <laugh> , I

Speaker 2: 11:47

Think you're kind of a smart guy. I think you're kind of a smart guy . What , what about um, x-rays?

Speaker 3: 11:52

Uh, x-rays, you know, x-rays can be helpful because patients with lupus can have arthritis. Sometimes we get x-rays of the hands because it can help differentiate that the patient does not have rheumatoid arthritis. Now, interestingly, because again, it's autoimmune disease, some patients have two autoimmune diseases. Some, some patients we find they have lupus and then we do x-ray. They actually have also rheumatoid arthritis. Mm-hmm . So we call it to lupus. Okay. So patients have both lupus,

Speaker 2: 12:18

I can't yr like that, roha <laugh> .

Speaker 3: 12:20

So, but x-rays are helpful but not, they're helpful to exclude other, other diseases that are present with lupus, but not for lupus per se. If that makes sense. I

Speaker 2: 12:28

Think I know the answer to this, but how important is it to diagnose it early?

Speaker 3: 12:32

Yes. Uh, lupus is very important to diagnose it early because if we diagnose it early, there are some medications and interventions we can do that limits its progression or decreases the risk of it progressing to involve internal organs. 'cause the challenge of lupus is when it's in the skin and the joint, it's bothersome to the patient. Absolutely. And it's, it's bothersome and we can treat it. But once it's involved , the internal organs becomes more challenging and rarely, sometimes life threatening or organ threatening, especially for the kidneys. So a lot of patients who develop lupus nephritis might end up on dialysis or ultimately need kidney transplant. So the importance of early diagnosis is early intervention to reduce the risk of progression of internal organ involvement. So

Speaker 2: 13:11

We're gonna take a short break. I'm talking with Dr. Rahad Nasser . He heads up the rheumatology division at Hennepin Healthcare and is the smartest guy I know. When we come back, we'll talk about treatment options for lupus and what else you need to know about this disease. Stick around, we'll be right back.

Speaker 4: 13:26

When Hennepin Healthcare says we are here for life, they mean here for you, your life and all that it brings. Hennepin Healthcare has a hospital HCMC and a network of clinics both downtown and across the west metro. They provide all the primary care and specialty care you would expect to find, but did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis. Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 14:05

And we're back talking about lupus with Dr. Rahad Nasser . So Rahad , is there anything you can do to avoid this or is this just something you're destined to get?

Speaker 3: 14:14

Well, there are some , uh, preventative measures that patients can do, but also these measures could be related to general health. For example, smoking, you know , um, smoking cessation. Avoiding smoking reduces the risk of patients developing lupus. Now of course, exercising and eating healthy and sleeping well are always things we encourage our patients in general to do. And they do reduce the risk of lupus. But as you know, or

Speaker 2: 14:37

At least reduce your risks of symptoms if you do have it correct.

Speaker 3: 14:41

So you're right, if you , if the , if the healthy lifestyle and avoided smoking either reduces the risk of having it and if the patient develop it, usually the symptoms are milder. So it can come in a milder form or delay its progression. Now obviously a lot of people do all these right things and they still develop severe lupus because of that genetic predisposition we spoke about.

Speaker 2: 15:01

So let's talk about treatment. What are the steps you take when someone gets the diagnosis? So

Speaker 3: 15:05

The first thing we do when we diagnose someone with lupus, everybody has to be on a medication called hydroxychloroquine or Plaquenil. At least we try it for everybody. We offer it for everybody, we counsel it for everybody

Speaker 2: 15:16

Because it's the first thing you use.

Speaker 3: 15:17

It's the first thing you use. Because hydroxychloroquine, even if it doesn't help the symptoms in the long term , it showed , uh, it , it was very beneficial in reducing the risk of developing lupus in your internal, in the patient's internal organs. People who took hydroxychloroquine versus who did not. And had lupus lived longer, had less lupus flares, had less heart attacks and strokes, cardiovascular events. So it's a very beneficial medication in the long term . So

Speaker 2: 15:41

Everybody should be on hydroxychloroquine if they tolerate has lupus. Correct . Now many listeners might remember that drug made a big splash about five years ago. Yes. <laugh> during the Covid pandemic. Correct. It's where hydroxychloroquine became part of everybody's daily vocabulary because there was this miff , I'm gonna go with Miff that it treated COVID , uh, but you've been using it for a much longer period of time for a different reason. Right. I just want to clarify.

Speaker 3: 16:09

Yes. Hydroxychloroquine has been used for lupus for a long time. We use at a low safe dose and most patients tolerated. And it's, it's a , it's a very important medication in lupus to try. Obviously there's a minority of patient lupus who don't tolerate the medicine, so we stop it. But if a patient has lupus, they have to at least have tried to take this

Speaker 2: 16:26

Medicine. Okay, so what's next after that? Yes . Because that one's an old medicine. Correct.

Speaker 3: 16:30

Then , uh, as part of the old medicines, the interesting part of lupus is which organ it is involving. You use a medication for it. So if it's involving the skin and the joints, it's a set of medications. If it's involving an internal organ like kidneys or lungs or heart or the brain, it's another set of medications. Now , uh, the old school medication we use is a medicine called methotrexate, which helps skin and joint disease. We've used azathioprine, another old school medicine that helps skin and joint disease. Now, if the kidneys are involved, we use a medicine called mycophenolate mofetil or even a form of chemotherapy cyclophosphamide that can help the kidneys. And

Speaker 2: 17:03

None of those are advertised on tv?

Speaker 3: 17:06

No , they're not. But they're solid.

Speaker 2: 17:07

But so , so those, that's why that's kind of why I call 'em the old school ones because about two thirds of TV commercials for medications say, ask your rheumatologist if yes , blah, blah , blah is right for you. Well you're a rheumatologist. So what are the new school

Speaker 3: 17:22

Ones? Yes . So for the new uh , medications , uh, biologics, we have two biologics for lupus. Uh, one is called benlysta or belimumab. It reduces B cells , a type of white blood cells. And the other one is called, it's a new medicine that just recently got FDA approved , it's called salo , which , um, blocks the interferon pathway. And uh, we use these medications for skin joint , uh, disease. And I'll have to say the , the latest medication salo has been very effective , uh, in lupus medication. And it was a celebration neuro rheumatology community when these medications came up . 'cause these are the first FDA approved medications for lupus for years and decades, we did not have anything that was FDA approved , uh, except the hydroxychloroquine.

Speaker 2: 18:02

Everything else was, it was you were using medications designed for something else

Speaker 3: 18:07

Off-label by experience of , I don think I knew that. Yeah. So the new biologics, they've,

Speaker 2: 18:12

They

Speaker 3: 18:12

Actually approved for lupus? Yes. And I have to say , uh, they're actually more effective. We have more medications to offer patients than previous years to help with their lupus.

Speaker 2: 18:20

Before I get off on medications, I wanna talk about one that many people have heard of Prednisone. When should a patient with lupus be taking prednisone?

Speaker 3: 18:27

Yes. So patients with lupus, we do start them on prednisone. Now, again, in the past, before all these meds, a lot of patients were on prednisone, high doses for a long time

Speaker 2: 18:36

Now with side effects, Melissa , as long as your arm. Yeah , yeah .

Speaker 3: 18:39

But now prednisone, we do start patients on prednisone for lupus. But now we lower the dose, we taper it down to a reasonable dose or even to zero in some situations with the new medications. But a lot of patients with lupus are still on low dose, like five milligrams of prednisone

Speaker 2: 18:54

Because it's an inflammatory condition. It's , and there's no better anti-inflammatory than prednisone,

Speaker 3: 18:58

Than prednisone. Yeah . So prednisone still work and we try to manage the side effects around it or keep it at a low dose. The other thing I'll mention is we do screen for vitamin D, 'cause vitamin D deficiency. We try to replenish vitamin D , uh, because it decreases risk of , uh, lupus flareups and might help with some of the patient's symptoms like fatigue particularly. But again, it's not like very clear it'll help. But it's something we do intervene to try to help with some of the symptoms.

Speaker 2: 19:23

I wanna shift into talking about the impact on people's lives. When you have a, a systemic condition, when I say systemic, I mean it's touching on all these organs of your body. A systemic condition that is a chronic condition that we manage. I'm gonna , I'm gonna go out on a limb and say that we don't have a cure for in lupus case, right?

Speaker 3: 19:41

Correct. We do not have a cure for lupus. We have medicines that suppress the immune system enough so it doesn't attack our own body and cause trouble.

Speaker 2: 19:49

So let's talk about the impact that might have on someone's life. Um , depending, you know, you , it could be any one of these organs, but a lot of these things aren't visible to other people and yet people are living with this every day . Can you think of how in your patients, how living with lupus can affect their lives?

Speaker 3: 20:05

It's very hard. Living with lupus is very hard for, for multiple reasons. One, it's a chronic disease that for which there's no cure. There's these medications that keep it in remission keeps the immune system for not flaring up and attacking the body. And so these medications also have potential side effects. So they require a lot of monitoring, a lot of clinic visits, a lot of lab testing. And then sometimes you have to go through trial and error of medications till you get the right medication . Sometimes it takes a year to get the patient on medicine that they tolerate and works for their disease. So there is the chronicity of the disease and the , the disease itself is complicated and requires these medications that require a lot of monitoring, a lot of clinic visits. So it's a lot of stress on the person just dealing with the disease. Also, patients with lupus mentioned they have a, a lot of fatigue. A lot of pain, and then a lot of brain fog, difficulty finding words, memory issues. And so a lot of times they are struggling in their workplace or with their family and people might not understand what is going on. And I've seen a lot of patients who go on disability because of lupus. 'cause they cannot function even mentally, not just physically. So it's a disease that can stress both the mental state and the physical state and they cannot perform as they used to at their workplace.

Speaker 2: 21:15

Yeah , I won't say her name, but I have a good friend who's a , a brilliant, intelligent, smart physician who has lupus. And it's challenging to get through a day with things that people can't see with fatigue and pain and that brain fog that you're talking about. Absolutely . And so you do and and , and people don't understand , uh, because they can't see that it , it , it , there's no nothing that the casual observer, but she would probably echo what you just said, that sometimes it's very hard to get through your day. Uh, um, and , and it can be disabling

Speaker 3: 21:45

Absolutely mentally and then energy wise , you know, a a little bit of effort in lupus patient can cause a lot of fatigue and requires a lot of rest for the body to to, to get that energy back to where it should be so that they can function. Talk about

Speaker 2: 21:57

The future. We've now got some medicines that are specifically FDA approved for lupus. What do you see down the road?

Speaker 3: 22:04

Yeah , so for the future, there are many medications right now in the pipeline we call like that are on studies to try to control lupus better. Um, as I mentioned, the recent medicines of nlo is a breakthrough. I think by experience, especially with the latest rheumatology conferences. In addition to the studies and the ads , the experienced by rheumatologists , we're seeing good response with this medicine anecdotally. But there are many medication in the pipeline that promise to keep this disease in remission. We don't have cures again, we have medicines that suppress the immune system.

Speaker 2: 22:32

A cure would've to be, would've to go after the genetic component, wouldn't it? Correct.

Speaker 3: 22:36

It would be like maybe a gene therapy in the future. The other thing in the future that can help us to avoid the trial and error of medicine, if there is like a genetic testing that tells us this patient has this type of lupus and respond to this medicine, instead of trying four or five medication till you reach the medication that will help. This is it. You

Speaker 2: 22:53

Get it right the first time with all that trial and error. Yeah. And the

Speaker 3: 22:56

Challenge of these medicines, each one takes about three months to try to see if it works. It's not like a medicine you try for a week and say, yep , it worked for my lupus. You have to take it for three months before you considered it failed. 'cause some patients it takes three months on the medicine to calm that part of the immune system that is hyperactive and causing trouble. So if

Speaker 2: 23:12

You knew ahead of time medicine A is likely to be more helpful for your style of lupus than medicine B, you would know which one to use right from the beginning.

Speaker 3: 23:20

That would be absolute dream for a

Speaker 2: 23:23

Rheumatologist . Yeah, I'll bet that'd be good.

Speaker 3: 23:23

And for the patients. Yeah.

Speaker 2: 23:25

Yeah,

Speaker 3: 23:25

Absolutely.

Speaker 2: 23:26

Lupus, that's a disease that we've been talking about with Dr. Awad Nasser, a rheumatologist and good friend of mine here at Hennepin Healthcare. If you have , um, concerns about rheumatologic diseases, whether it be lupus or any of the other ones , um, that we mentioned earlier, whether it be rheumatoid arthritis or maybe it's about gout, you don't get a better set of rheumatology colleagues than you do at here at Hennepin Healthcare in downtown Minneapolis. Okay. If you could leave us with one or two things for people to take home about lupus, what would they be?

Speaker 3: 23:54

One, you know, my experience with patient with lupus, they need a lot of psychosocial support. So if you know someone who has lupus, please try to help them as much as you can, support them socially, be very patient with them and try to understand where they're coming from. It's hard to see pain, fatigue and brain fog. Mm-hmm <affirmative> . But I've seen too many people go on disability because of this disease. And I'm hoping in the future we can find a really good medicine and as I said, try to avoid the error and trial and try to get this disease control so people can live their lives as best as

Speaker 2: 24:25

They can. I like that, the human aspect of it. If you know somebody with symptoms or you know somebody with diagnosis, some, some support networks are a great idea.

Speaker 3: 24:33

Absolutely. We always try to encourage spouses to come sometimes with the patients so that they can understand where we're coming from and where the patient's coming from.

Speaker 2: 24:40

Awa thanks for being on the show.

Speaker 3: 24:41

Thank you for having me, David . It's

Speaker 2: 24:43

Always pleasure. It's been , it's been great having you. We've been talking about Lupus with Dr. Rahad Nasser here at Hennepin Healthcare from sunny downtown Minneapolis. I hope you've picked up some new tips from this as I have. And I hope you'll join us for our next episode in two weeks time. And in the meantime, be healthy and be well.

Speaker 1: 25:00

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At highball Executive producers are Jonathan, CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern . Until next time , be healthy and be well .