If you missed in “The Rheum” with Dr. Winn Chatham, you really missed in a good session. Take your time to listen and learn about Lupus, next forum in May during Lupus Awareness month.
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In the Rheum with Dr. Chatham
Meeting Summary from March 13, 2026
Quick Recap
This meeting was a Q&A session with Dr. William Chatham, a rheumatologist at UNLV, hosted by Colors of Lupus Nevada. The discussion covered various aspects of lupus diagnosis, treatment, and management.
Dr. Chatham explained that lupus is a clinical diagnosis that relies on patient symptoms, physical exams, and laboratory tests beyond just ANA levels.
He discussed the unpredictability of lupus flares, the importance of understanding remission (which requires no symptoms and no prednisone), and the challenges of diagnosing lupus due to its varied presentations.
The conversation addressed overlapping autoimmune diseases, central nervous system lupus, and the need for better education among healthcare providers.
Dr. Chatham also touched on the shortage of rheumatologists in Las Vegas and the importance of early diagnosis, particularly for patients with family history of lupus.
The session concluded with questions about disability benefits and vaccine recommendations for lupus patients.
Summary
Lupus Diagnosis and Misdiagnosis
Autumn interviewed Dr. Chatham, a rheumatologist specializing in lupus, about lupus diagnosis and misdiagnosis.
Dr. Chatham explained that lupus is primarily a clinical diagnosis based on patient history, symptoms, and examination findings rather than relying solely on laboratory tests like ANA.
He noted that ANA test results can fluctuate over time and may become negative due to treatment, but this doesn’t necessarily mean the lupus diagnosis is incorrect, just that the disease may not be actively affecting antibody levels at that moment.
Lupus Diagnostic Testing Methods
Dr. Chatham explained that while the ANA test is commonly associated with lupus diagnosis, it’s not the only testing method used, especially in early stages of the disease.
They discussed other lupus-specific antibody tests and complement protein measurements that can provide additional diagnostic information.
Dr. Chatham noted that ANA levels don’t correlate well with disease activity, which is why they typically don’t recheck ANA positivity once it’s documented, while other antibody titers and complement proteins do correlate with disease activity.
Lupus Symptoms and Presentation
Dr. Chatham explained that lupus can present with two main types of activity: serologic activity driven by autoantibodies and interferonopathy, which affects about 25% of lupus patients.
He detailed common symptoms beyond fatigue and joint pain, including chest pain, gastrointestinal issues, kidney problems, and nervous system effects.
Dr. Chatham emphasized that lupus can affect any organ system, and patients should seek evaluation for unexplained symptoms that might indicate a lupus flare.
Lupus Treatment and Management Strategies
Dr. Chatham explained lupus as a disorder where the immune system reacts with parts of the body instead of attacking viruses and bacteria, often due to genetic and environmental factors.
They discussed how treatments like hydroxychloroquine address high interferon levels and autoantibodies.
He outlined epigenetic factors that can trigger or exacerbate the disease, including infections, stress, hormones, sunlight exposure, and diet.
Dr. Chatham emphasized that while genetics cannot be controlled, patients can manage epigenetic factors through stress management, diet, sun exposure, and exercise to influence their disease outcomes.
Lupus Risk Factors and Prevalence
Dr. Chatham explained that lupus is more prevalent in women due to estrogen effects and immune cell functions specific to females.
He noted that racial predispositions to lupus are being studied, with Native American ancestry carrying the highest risk, followed by African ancestry.
Dr. Chatham also discussed how social stress factors, including discrimination and unequal opportunities, may contribute to lupus flares and severity.
Regarding the unpredictability of lupus, Dr. Chatham explained that while life events and infections can trigger flares, much of the unpredictability stems from epigenetic factors rather than genetics.
Lupus Flare Management Discussion
Autumn discussed the unpredictability of lupus flares with Dr. Chatham who explained that flares represent increased lupus activity.
This activity can be measured through laboratory tests or experienced as symptoms like fatigue, fevers, and joint pain.
Dr. Chatham noted that flares can vary significantly in duration, from brief episodes lasting just a day to longer periods requiring medication adjustments.
When addressing family members, Dr. Chatham advised them to understand that appearance doesn’t indicate how someone with lupus is feeling.
He recommended rest during flares and comparing the experience to having the flu, while emphasizing the importance of not judging someone’s condition based on their appearance.
Overlapping Autoimmune Diseases Discussion
The discussion focused on overlapping autoimmune diseases, particularly in lupus patients.
Dr. Chatham explained that genetic predispositions can lead to multiple autoimmune diseases, with Native American ancestry patients in Las Vegas commonly experiencing overlapping conditions.
Autumn shared her experience of being diagnosed with two autoimmune diseases by Dr. Chatham contrasting this with other local rheumatologists who typically only test for lupus.
The conversation ended with an unasked question about remission criteria.
Lupus Remission Criteria Discussion
Dr. Chatham explained that remission in lupus requires absence of measurable disease activity, low provider-perceived global assessment, and no symptoms including fatigue or joint pain, as well as being off prednisone.
Dr. Chatham noted that while patients with kidney disease should remain on treatment for at least two years after diagnosis, those with milder symptoms might be able to de-escalate treatment including staying on hydroxychloroquine.
The discussion ended with Autumn asking about patients who require long-term low-dose prednisone due to CNS lupus or active skin involvement.
CNS Lupus Treatment Challenges
The discussion focused on central nervous system (CNS) lupus, highlighting its underrepresentation in lupus trials due to patient exclusion.
The speaker emphasized the importance of using steroid-sparing immunosuppressive therapies, such as mycophenolate and rituximab, to manage CNS lupus effectively.
They also discussed the need to distinguish between symptoms caused by active disease and permanent damage.
They mentioned developing interventions like low-dose naltrexone for cognitive issues.
The conversation concluded with the challenges of diagnosing and treating CNS lupus, emphasizing the importance of patient communication regarding neurocognitive symptoms.
Rheumatologist Shortage in Las Vegas
Dr. Chatham discussed the efforts to increase the number of rheumatologists in Las Vegas, noting that while they are building a pipeline through training programs, there is still a shortage of specialists in the area.
He explained that having trainees has doubled or tripled their clinical capacity, allowing for more lupus patients to be seen and potentially expanding into clinical trials and research registries in the future.
Autumn inquired about improving understanding of lupus among emergency room doctors and hospitalists.
Lupus Diagnosis Challenges Discussion
Dr. Chatham discussed the challenges in diagnosing lupus, explaining that it requires pattern recognition of symptoms that aren’t unique to the disease.
He noted that most patients won’t see a rheumatologist in the hospital unless the hospital has a rheumatology training program, which is rare.
Dr. Chatham emphasized the importance of considering family history when diagnosing lupus and highlighted the educational efforts being made to improve awareness among healthcare providers.
The conversation ended with a question about SSI disability for lupus patients.
Lupus Disability and Treatment Guidelines
Dr. Chatham discussed how Social Security boards determine disability claims for lupus patients, noting that severe manifestations like strokes or lung disease are easier to prove than debilitating fatigue and cognitive dysfunction.
He advised that patients with family history of lupus and concerning symptoms, even with low ANA titers, should be further investigated.
Dr. Chatham explained that while patients with lupus should generally avoid live virus vaccines, they should receive other vaccinations including influenza, RSV, and pneumococcal vaccines to prevent flares.
He clarified that mixed connective tissue disease is treated similarly to lupus with a focus on managing all manifestations rather than prioritizing one condition over another.