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Treatment

For the vast majority of people with lupus, effective treatment can minimize symptoms, reduce inflammation, and maintain normal bodily functions.

Preventive measures can reduce the risk of flares. For people who are photosensitive, avoidance of (excessive) sun exposure and/or the regular appliction of sun screens will usually prevent rashes. Regular exercise helps prevent muscle weakness and fatigue. Immunization protects agains specific infections. Support groups, counseling, talking to family members, friends, and physicians can help alleviate the effects of stress. Needless to say, negative habits are hazardous to people with lupus. These include smoking, excessive consumption of alcohal, too much or too little of prescribed medication, or postponing regular medical checkups.

Treatment approaches are based on the specific needs and symptoms of each person. Because the characteristics and course of lupus may vary significantly among individuals, it is important to emphasize that a thourough medical evaluation and ongoing medical supervision are essential to ensure proper diagnosis and treatment.

Medications are often prescribed for people with lupus, depending on which organ(s) are involved, and the severity of involvement. Effective patient-physician discussions regarding the selection of medication, its possible side effects, and any changes in doses are vital. Commonly prescribed medications include:


Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

These medications are prescribed for a variety of rheumatic diseases including lupus. Examples of such compounds include acetylsalicylic acid (e.g. aspirin), ibuprofen (Motrin), naproxen (Naprosyn), indomethacin (Indocin), nabumetone (Relafen), tolmetin (Tolectin) and a large number of others. These drugs are usually recommended for muscle and joint pain, and arthritis. Aspirin and NSAIDs may cause stomach upsets for some people. This effect can be minimized by taking them with meals, milk, antacids, or prostaglandins such as misoprostil (Cytotec). Newer NSAIDs contain a prostaglandin in the same capsule (Arthrotec). The other NSAIDs work in the same way as aspirin, but may be more potent, and patients often required fewer pills per day to have the same effect as aspirin. Many NSAIDs are now available "over the counter". People should be cautions about taking too much aspirin or NSAID since too many of these can reduce the blood flow to the kidney and cause problems.


Acetaminophen

Acetaminophen (e.g. Tylenol) is a mild analgesic that can often be used for pain. It has the advantage of less stomach irritation than aspirin, but it is not nearly as effective at suppressing inflammation.


Corticosteroids (Steroids)

Corticosteroids are hormones that have anti-inflammatory and immunoregulatory properties. They are normally produced in small quantities by the adrenal gland. This hormone controls a variety of metabolic functions in the body. Synthetically produced corticosteroids are used to reduce inflammation and suppress activity of the immune system. The most commonly prescribed drug of this type is Prednisone.

Because steroids have a variety of side effects, the dose has to be regulated to maximize the beneficial anti-immune/anti-inflammatory effects and minimize the negative side effects. Side effects occur more frequently when steroids are taken over long periods of time at high doses (for example, 60 milligrams of Prednisone taken daily for periods of more than one month). Such side effects include weight gain, a round face, acne, easy bruising, "thinning" of the bones (osteoporosis), high blood pressure, cataracts, onset of diabetes, increased risk of infection, stomach ulcers, hyperactivity, and an increase of appetite.


Antimalarials

Chloroquine (Aralen) or hydroxychloroquine (Plaquenil), commonly used in the treatment of malaria, may also be very useful in some individuals with lupus. They are most often prescribed for skin and joint symptoms of lupus. It may take months before these drugs demonstrate a beneficial effect. Side effects are rare, and consist of occasional diarrhea or rashes. Some antimalarial drugs, such as quinine and chloroquine, can affect the yews. Therefore, it is important to see an eye doctor (ophthalmologist) regularly. The manufacturer suggests and eye exam before starting the drug and one exam every six months thereafter. However, your physician might suggest a yearly exam is sufficient.


Immunomodulating Drugs

Azathioprine (Imuran) and cyclophosphamide (Cytoxan) are in a group of agents known as cytotoxin or immunosuppressive drugs. These drugs act in a similar manner to the corticosteroid drugs in that they suppress inflammation and tend to suppress the immune system. The side effects of these drugs include anemia, low white blood cell count, and increased risk of infection. Their use may also predispose and individual to developing cancer later in life.

Other agents like methotrexate and cyclosporin are used to control the symptoms of lupus. Both are immunomodulating drugs which have their own side effects. These drugs are still in the investigational phase for lupus. Some of these agents are used in conjunction with apheresis, a blood filtering treatment. Apheresis has been tried by itself in an effort to remove specific antibodies from the blood but the results have not been promising.

Newer agents are directed toward specific cells of the immune system. These include agents, which block the production of specific antibodies like those against DNA, or agents which act to suppress the manufacture of antibodies through other mechanisms. Examples of this are intravenous immunoglobulin injections which are given on a regular basis to increase platelets.


Anticoagulants

These drugs are employed to thin the blood or in actuality, to prevent blood from clotting rapidly. They range from aspirin at a very low dose which prevents platelets from sticking, to heparing/coumadin which actually prevent the blood from clotting. The latter requires careful monitoring to insure that the patient is in the "therapeutic range" or that the blood is not excessively "thin". Generally, this type of therapy is life-long in people with lupus and follows an actual episode of clotting (embolus or thromboses).

People with lupus should learn to recognize early symptoms of disease activity. In that way they can help the physician know when a change in therapy is needed. Regular monitoring of the disease by laboratory tests can be valuable because noticeable symptoms may occur only after the disease has significantly flared. Changes in blood test results may indicate the disease is becoming active even before the patient develops symptoms of a flare. It seems that the earlier such flares are detected, the more easily the can be controlled. Also, early treatment may decrease the chance of permanent tissue or organ damage and reduce the time one must remain on high doses of drugs.




All information is from:
Robert G. Lahita, M.D., PH.D.
Chief, Division of Rheumatology and Connective Tissue Diseases
St. Luke's/Roosevelt Hospital Center

Associate Professor, College of Physicians and Surgeons
Columbia University, New York, NY


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