Johns Hopkins Lupus Center Reviews: 2025 Sunspots & Milder Lupus?

Johns Hopkins Lupus Center Reviews: Could sunspots in 2025 lead to milder lupus?

Largest sunspot in 2014 picture by NASA may predict lupus flares

2014 photo by NASA showing an 80,000 mile long sun spot (the length of 10 Earths side by side). Photo source Wikipedia Commons and NASA, Greenbelt, MD
Johns Hopkins Lupus Center reviews of sunspot patterns: lupus disease activity varies with sunspot cycles

– The Johns Hopkins Lupus Center reviews many ways that lupus is affected by the environment. It appears that the pattern of sunspot formation may be one of them.
– Previous research in Germany suggested health changes related to magnetic storms and sunspots (specifically while studying heart attacks by Halberg F, et al.)
– The Lupus Clinic at Johns Hopkins compared disease activity in their center from 1996 to 2020 and compared it to solar cycles, sunspots, and geometric disturbances.
– They found that increased sunspots (called solar maximum in the solar cycle) was followed by lower disease activity on average in their patients.
– Increased geomagnetic activity was also associated with lower disease activity.
– This is another study suggesting how important our environment is regarding lupus. 

When will there be milder lupus activity as predicted by sunspots?

– Of course, this is all hypothetical, and this research needs to be reproduced.
– If it is correct, our most recent time of fewer sunspots was DEC 2019 (the least solar activity in 100 years)
– NASA predicts that solar maximum will occur in July 2025 with 115 sunspots (179 is the average)
– The previous solar maximum was in APR 2014 with 114 sunspots. Since Dr. Stojan’s research included that sun cycle, this upcoming cycle should be similar.

– Therefore, SLE patients may look forward to the Fall and Winter, Northern Hemisphere (this was a Northern Hemisphere study) of 2025 as a period of having milder lupus attacks.

Note… this is all very interesting, but I would not put my money on it until further research is done

Author

 Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets

References:
Stojan G, Giammarino F, Petri M. Systemic lupus Erythematosus and geomagnetic disturbances: a time series analysis. Environ Health. 2021 Mar 16;20(1):28. doi: 10.1186/s12940-021-00692-4. PMID: 33722240; PMCID: PMC7962208.

Halberg F, Cornélissen G, Otsuka K, Watanabe Y, Katinas GS, Burioka N, Delyukov A, Gorgo Y, Zhao Z, Weydahl A, Sothern RB, Siegelova J, Fiser B, Dusek J, Syutkina EV, Perfetto F, Tarquini R, Singh RB, Rhees B, Lofstrom D, Lofstrom P, Johnson PW, Schwartzkopff O, the International BIOCOS Study Group. Cross-spectrally coherent ~10.5- and 21-year biological and physical cycles, magnetic storms and myocardial infarctions*. Neuro Endocrinol Lett. 2000;21(3):233-258. PMID: 11455355.

NASA: What Will Solar Cycle 25 Look Like?

Provocative Advice: Lupus Patients need COVID Vaccines [2021]

Evaluation and recommendations by noted lupus experts: Lupus patients need COVID vaccines

Newspaper on fire about lupus patients and COVID-19 vaccines

Hot off the press from Lupus Science & Medicine
revised 6/13/21: Added mycophenolate, NSAIDs, and Tylenol to the list of drugs that should be held for vaccines

SARS-CoV-2 vaccines in patients with SLE
Link and reference below to the research studiesSummary of some main points (but I encourage you to read the article):

– This article is written by some of the world’s experts in lupus
– Dr. Joan Merrill, Dr. Anca Askanase, Dr. Wei Tang, and Dr. Leila Khalili

“… the risks of not receiving the vaccine are far greater at the present time.”

 The lupus experts also state,
“Patients with autoimmune rheumatic diseases should receive the COVID-19 vaccines and should be prioritized before the general population.”
– Other vaccines have been shown to be safe in lupus patients.
– They recommend temporarily stopping or changing the dosing schedule on some drugs, such as cyclophosphamide, methotrexate, mycophenolate (CellCept, Myfortic), rituximab (Rituxan), abatacept (Orencia), JAK inhibitors (Xeljanz, Olumiant, Rinvoq), NSAIDs, and Tylenol.

They recommend following the recommendations of the American College of Rheumatology (click on link)

– They recommend that doctors may want to consider monitoring antibody levels after the vaccine.
– Since we do not know how well lupus patients, patients with other autoimmune diseases, and immunosuppressed patients will respond to the vaccines, they should continue strict social distancing.
– The above recommendations are made without research regarding specifically these RNA vaccines. However, after evaluating all the data, The American College of Rheumatology and these lupus experts recommend vaccination in patients with autoimmune rheumatic diseases. 

What are the risks of COVID-19 infection when lupus patients get infected?

– They are not at higher risk for infection from the novel SARS-CoV-2 Coronavirus.
– However, they are at higher risk of hospitalization than the general population.
– COVID-19 infection may even increase lupus flares.

Please get your vaccine.  I got mine and I recommend it to all my patients.
This is not a substitute for your doctor’s advice. Please check with your physician first. 

Author

Don Thomas, MD: author of “The Lupus Encyclopedia” and “The Lupus Secrets

References:
Tang W, Askanase AD, Khalili L, et al. SARS-CoV-2 vaccines in patients with SLE. Lupus Science & Medicine 2021;8:e000479. doi: 10.1136/lupus-2021-000479

​American College of Rheumatology (ACR) COVID-19 Vaccine Clinical Guidance Task Force. COVID-19 vaccine clinical guidance summary for patients with rheumatic and musculoskeletal diseases, 2021www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf. Available: https:///www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdfGoogle Scholar

Melatonin For Lupus May be Good Per the Best Medical Evidence [NEW!]

Melatonin For Lupus: What does the Research Show?

 

Melatonin for lupus being produced by the pineal gland in lupus
Melatonin is produced by the brain when it starts to get dark. Melatonin for lupus– could it be a good, safe sleep aid? … Photo from Wikipedia “Melatonin” by Srruhh

 

 

(Updated August 2021)

Why do people think that melatonin for lupus patients is unsafe?

Many people think that melatonin for lupus and other autoimmune diseases is unsafe. I believe it is due to there being outdated websites and patient education pages that state this. For example, it even occurs on highly-acclaimed sites such as the Mayo Clinic.

However, how can the Mayo Clinic be wrong?
Without a doubt: many excellent websites produced their patient education pages a long time ago.
In addition, there are not enough staff to check and update them on a regular basis.
Certainly the doctors are way too busy to do this: they are taking care of patients and doing research.

 

Read more

The Anti-SSA Test (also called anti-Ro): Know Your Lupus Labs

What is the anti-SSA test?

Anti-SSA (anti-Ro) in a lupus patient

What the lab technician sees under the microscope when testing a patient for anti-SSA antibodies. These are human epithelial cells to which blood was added from a patient who has anti-SSA antibodies, proving that that person is positive for anti-SSA. Photo credit below
Know your labs, such as the anti-SSA test when you have lupus!
The anti-SSA test is also called SSA antibody I recommend that all lupus patients get copies of their labs every time they are done. Look up any abnormal results from a reliable source to know what they mean. If you cannot find a reliable source, then ask your doctor.

Remember… Knowledge is Power!

So, let’s talk about anti-SSA (also called anti-Ro).

Read more

Lupus Nephritis Diagnosis: Now in a nutshell in this video

Lupus Nephritis Diagnosis in easy-to-understand language

Diagram of kidney in lupus nephritis

40% of SLE patients will develop kidney inflammation (lupus nephritis diagnosis)

Lupus inflammation of the kidneys (lupus nephritis diagnosis, LN) video below:

– A lupus nephritis diagnosis affects 40% – 50% of SLE patients
– People with lupus nephritis do not feel badly until it becomes severe. Many people are surprised to hear this, but this is why we ask lupus patients to give us a urine sample regularly even when they feel great. When symptoms such as swelling, high blood pressure, and fatigue occur, there is usually significant damage already being done.
– This is why your rheumatologist asks you to do a urine sample every 3 months (hopefully)
– This is why you should do a frequent urine sample. The faster it is diagnosed, the faster it is treated, the higher the chances for remission
– These are unprecedented times for LN. We have the 1st two ever FDA-approved drugs for LN
Lupkynis (voclosporin, 1/22/21) and Benlysta (belimumab, 12/17/20)
– Both of these drugs greatly increase the chances for remission, allowing less usage of steroids

– We are able to diagnose and treat a lupus nephritis diagnosis better than ever. The recommendations in this video are in line with what the experts recommend, but it is in easy-to-understand terms. The first step is to identify as fast as we can by getting a urine sample and looking for excessive protein in the urine.

– Preventing and treating lupus nephritis takes a lot more than taking drugs. Eating an anti-inflammatory diet, exercising regularly, practicing mindfulness, learning how to lower stress, seeing your doctors regularly are all important.

​     – WATCH THE VIDEO TO LEARN MORE ABOUT LUPUS NEPHRITIS!
     – Brought to you by Aurinia, Lupus Chick, The Lupus Foundation of New England, and Don Thomas, MD

Author

Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets

Allergies and Itching after COVID vaccine? Announcing Research Here

Results from 64,900 vaccines: How often are allergies and itching after COVID vaccine?

Urticaria hives allergic reaction in systemic lupus erythematosus SLE

Hives (urticaria) photo credit: James Heilman, MD, Wikipedia, “Hives”

​Journal of the American Medical Association Research Study: March 2021

(reference and link to the study are at the bottom of the page)

Easy-to-Read Results Summary:

– Researchers did this study based on the fact that many are nervous to get the vaccines due to having allergies themselves and all the media-hype regarding allergic reactions causes some people to avoid the vaccines.

So… what is the truth?
– Study was done at Massachusetts General Brigham (the Original Harvard hospital!)
​- Studied what happened the 3 days after the first vaccine (the time of highest chances for allergy symptoms)
– 40% got Pfizer, 60% Moderna

Mild allergic reactions
– 1 out of every 50 vaccines caused mild allergic reactions (itch, hives, swelling)
– Moderna (2.2% of the shots caused mild allergy) vs Pfizer (2% of the shots): not much difference
– 98% of all people had no allergic reactions at all (that is a nice, safe number)

Significant allergic reactions (anaphylaxis)
– Occurred in 1 out of every 3700 Pfizer shots (i.e. .027% of the shots)
– Occurred in 1 out of every 4300 Moderna shots (i.e. .023% of the shots)
– In total, there were 5 anaphylactic reactions per 20,000 vaccines (that is a really safe number compared to many other drugs)

Moderna and Pfizer COVID-19 mRNA vaccines for lupus patients

Pfizer and Moderna were pretty similar in how often they caused allergic reactions: very low numbers
​Timing for significant allergic reaction (anaphylaxis)
– An average of 17 minutes after the shot
– The range was from immediately after the shot up to 2 hours later at the latest
Anaphylaxis severity
– 7 of the 16 patients had mild skin reactions
– 9 of the 16 patients had “measurable” but not life-threatening reactions
– 3 did not seek any medical attention
– 1 went to the ICU and recovered
– 9 out of 16 patients needed an epinephrine shot (EpiPen) and all recovered
– There were no severe anaphylactic reactions (having shock or requiring intubation)

Who was most likely to get anaphylaxis?
– Out of 16 patients in total, 5 (31%) had a history of anaphylaxis
– 10 out of 16 (61%) had a history of allergies (probably not significantly different than the usual population)

“I have a history of anaphylaxis, what is my risk?”
– Assuming there were 4000 individuals with severe food or drug allergies in this group (this is the expected #)
– Only 5 out of 4000 people with a history of anaphylaxis get an anaphylactic reaction (1 out of every 800)
– Knowing that this is a group of people who are used to planning for anaphylaxis and should have an EpiPen, and who know they have to use it when exposed to a known allergen (like me when I accidentally eat shrimp), that is an incredibly low number.
– I took my EpiPen with me when I got mine. No problems! Only 1 out of every 800 times would someone need to use it

Bottom lines
– Since the results were reported by the employees themselves, and not confirmed by doctors, we cannot ensure that these were truly anaphylactic reactions (people do tend to overestimate such responses = my opinion)
– The researchers, Harvard-famous allergy experts, stated, “… the overall risk of anaphylaxis to an mRNA COVID-19 vaccine remains extremely low”

If you have had an anaphylactic reaction in the past (like I have), I recommend:
– Just take your EpiPen and wait a while after your shot if you have had anaphylaxis before. However, don’t sweat it.

You have a higher chance of getting into a car accident on the way to the shot than you do of getting an anaphylactic reaction

Did you get your vaccine? How did you do?
COMMENT BY CLICKING ON “Comments” ABOVE

​​

Author

Don Thomas, MD author of “The Lupus Encyclopedia” and “The Lupus Secrets

More COVID-19 deaths in rheumatic diseases: Latest study results

Research Shows More COVID-19 Deaths in Rheumatic Diseases: 10.5% of lupus and rheumatic disease patients died

Much higher rate than infected people without rheumatic disease

People with lupus and rheumatic diseases are at risk…
​What is the bottom line? What should you do?

Lupus patient in ICU hospital with COVID-19

Lupus patients and other rheumatic disease patients shown to have higher death rates per a recent large research study
Results of a world-wide study of 3729 rheumatic disease patients and COVID-19

– Earlier reports in early 2020 suggested that lupus patients may not have been at higher risk of COVID-19 complications. This report (referenced below) questions this.
– This report looked at 3729 patient. It included patients with systemic lupus, but it did not specify how many lupus patients nor how they did compared to other patients. However, it looked at the risk for death in patients receiving various drugs, patients with certain comorbidities, disease activity risks, sex, and countries of residence. 

BAD NEWS FOR LUPUS PATIENTS

FIRST THE BAD NEWS
BAD FINDINGS FROM THE STUDY

Rheumatic disease patients at highest risk for death after infected with COVID-19 (listed in order)
(these results will be given in odds ratios.
To figure out how to word this (odds ratio findings):
Subtract 1 from the number, move the decimal point 2 to the right, then say “___ greater odds of dying from COVID-19.”
For example, for an 80 year old with a rheumatic disease, they have a 518% greater odds of dying from COVID-19. A man with a rheumatic disease has a 68% greater odds of dying from COVID-19 infection than a woman does.”)

     – Age >75 years old, OR 6.18
– Rituximab (Rituxan) treatment, OR 4.04
– Sulfasalazine treatment, OR 3.60 (see commentary below)
– Age 66-75, OR 3.00
– Immunosuppressant treatments listed below, OR 2.22
(tacrolimus, mycophenolate, cyclosporine, cyclophosphamide, azathioprine)
– Not on a disease modifying agent immunosuppressant, OR 2.11 (compared to patients on methotrexate)
– Moderate to high disease activity, OR 1.87 (compared to patients in remission and low disease activity)
– High blood pressure plus heart disease, history of stroke, or hardening of the arteries, OR 1.89
– Prednisone more than 10 mg daily (or more than 8 mg methylprednisolone), OR 1.69 (compared to no steroids)
– Chronic lung disease (like COPD, asthma, interstitial lung disease, pulmonary fibrosis), OR 1.68

     – Men, OR 1.46 (compared to women)

United Kingdom had the highest death rate followed by Germany

________________________________________________________________

Commentary about sulfasalazine (SSZ): Do not take away from this that SSZ increases deaths from COVID-19. SSZ is often prescribed by rheumatologists to sicker patients who are at higher risk for infections in the first place. For example, there were more smokers in the SSZ group. SSZ does not suppress the immune system. Also, SSZ is a weak drug (most often used to treat rheumatoid arthritis). Patients on just SSZ are less likely to be in remission or low disease activity (and therefore at higher risk of death from a COVID-19 infection). I suspect that this is an “association” and not a “causality.”

Doctor giving good news to lupus patients about COVID-19

NOW, THE GOOD NEWS
POSITIVE FINDINGS FROM THE STUDY

– Hydroxychloroquine (Plaquenil) and belimumab (Benlysta) treatments were not associated with higher death
– TNF inhibitor, leflunomide, abatacept (Orencia), tocilizumab treatments were not associated with higher death
– The United States had the lowest death rate of all countries in the study
– After the US, countries (in order) of lowest death rates = Germany, then France, then Spain

Strategies to protect against COVID-19 when you have lupus

The Bottom Line: What you should do
BOTTOM LINE AND WHAT YOU SHOULD DO TO PROTECT YOURSELF:

It is most important to keep your lupus under control. Do NOT stop any medications.
Abide by all nondrug ways to lower lupus disease activity so you don’t need as many steroids.
– Work hard with your doctor to control your disease better so you can lower your steroid dose. 
– Get vaccinated against COVID-19!
– Ask everyone around you to get vaccinated (the cocoon strategy)
– Even after vaccination, abide by all isolation, separation, social distancing strategies

ReferenceStrangfeld A, Schäfer M, Gianfrancesco MA, et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Annals of the Rheumatic Diseases Published Online First: 27 January 2021. doi: 10.1136/annrheumdis-2020-219498

Author

Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets

DHEA and Lupus: Research shows it to be useful and good in some

Use of DHEA in lupus patients

Other Facts about DHEA and lupus

– DHEA and lupus: DHEA stands for DeHydroEpiAndrosterone
– It is produced by the adrenal glands
– It is made from cholesterol (yes, cholesterol is a necessary part of our body)
– It is both a steroid and a hormone
– It has both female hormone activity and male hormone activity
– It is used by the body to produce estrogen (female) and testosterone (male)
– It is the most abundant hormone in the human body
– Many lupus patients have lower than normal DHEA levels. This is what started the research to use it for treatment
– The prescription form of DHEA goes by the brand name Prasterone. The FDA would not approve its use for lupus due to the clinical trials not being strong enough to support FDA-approval.

– The research studies used 200 mg a day. However, this is more likely to cause acne and unwanted hair growth.

– It is best to get DHEA from a compounding pharmacist to ensure high quality. Ask your rheumatologist to write you a prescription. Over-the-counter products are not as reliable.

– It is available as a prescription vaginal preparation to help decrease pain from intercourse in women who have vaginal atrophy (tissue thinning usually due to aging).

– It does not look like the pharmaceutical company who produced Prasterone is going to pursue FDA-approval for treating systemic lupus erythematosus. Previous attempts to do this, backed up by positive recommendations from lupus experts failed.

– Using DHEA is one of the Lupus Secrets.

Want to learn more about DHEA and lupus? Read this online article that is free to download and read for everyone:

Sawalha AH, Kovats S. Dehydroepiandrosterone in systemic lupus erythematosus. Curr Rheumatol Rep. 2008;10(4):286-291. doi:10.1007/s11926-008-0046-1

Thanks to Kelli Roseta of More Than Lupus for publishing “Ask Dr. T”

Author

Donald Thomas, MD