Pain-Free Living

Lupus, Depression and Race

Joseph Gustaitis

Rheumatoid arthritis (RA) and lupus are different diseases, but they have a lot in common. For example, they both are autoimmune diseases—that is, a disease in which the body’s immune system mistakenly attacks normal cells. Also, they both are chronic diseases, and they both cause pain in the joints. Finally, research has revealed a genetic tie between lupus and RA that involves mutations of a gene known as STAT4. People who have this mutation have a higher risk of developing both lupus and RA. Some experts even use the term “lupus arthritis” to describe the arthritis that strikes people with lupus, according to healthline.com.

However, there is at least one major difference between the two conditions—the age of onset. Unlike arthritis, which largely is a disease of older people, lupus usually strikes between the ages of 15 and 44. According to lupus.org, lupus is prevalent in women of childbearing age, but men can get it, too, as can children and teenagers. Although it’s rare to get lupus before age five, about one in five people with the disease develops it before age 20, according to rheumatology.org. One of the issues with lupus in young people is that treatment often requires a more aggressive use of drugs.

Recently, a new study conducted at Children’s Hospital of Philadelphia looked at the relationship between lupus and mental health (specifically anxiety and depression) in young people. The researchers were not surprised to find that anxiety and depression are common in many children with lupus, but they didn’t expect to discover that the symptoms of depression and anxiety are even more common in nonwhite children. This finding is significant especially because lupus is more common in nonwhites (defined as African Americans, Hispanics, Asians, Native Americans and some smaller groups). Also, suicidal thoughts were found to be much more common in young people with lupus than in healthy children. Finally, the study showed young lupus patients with depression visited their primary health-care providers less often. These findings were troubling especially because the researchers also discovered few of the young people with lupus were getting mental health care.

Why would depression and anxiety be so frequent in young people with lupus? One thing the scientists pointed to was the frequency of lupus in girls in adolescence, which already is the period with the greatest risk for depression and anxiety. Of course, having any chronic illness can be a source of mental health problems, but lupus also can cause an inflammation of the brain that can contribute to these problems. Then there are issues involving medications. In the first place, doctors treating lupus with medications need to rely mostly on studies of older people, making it difficult to make choices about drug treatment for young patients. In the second place, medications such as steroids can affect a patient’s appearance—something particularly important during the teenage years.

Because the study was conducted on a single group of young people, the researchers advise that larger studies will be needed to verify their conclusions. Nevertheless, the study already has given scientists important new information. Most valuable are the observations that children of color who have lupus are more prone to depression and anxiety and that suicidal thoughts are quite frequent in this group. The study also shed new light on how the mental health problems that can accompany lupus in young people often are underreported and undertreated. As one of the authors of the study said, the research “provides insight for improving mental health intervention for these youth.”

Last Reviewed October 27, 2015

Joseph Gustaitis is a freelance writer and editor based in the Chicago area.

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