Lupus
Contents of this Article
Treating Lupus
There is no known cure for lupus, but there are treatments. Lupus can be effectively treated with drugs, and most people with the disease can lead active, healthy lives.
Diagnosing and treating lupus are often a team effort between the patient and several types of health care professionals.
A person with lupus can go to:
- A family doctor or internist
- A rheumatologist (pronounced - ROOM-uh-TOL-uh-jist) - a doctor who specializes in rheumatic diseases (arthritis and other inflammatory disorders, often involving the immune system)
- Clinical immunologists (pronounced - im-yuh-NOL-uh-jist) - a doctor specializing in immune system disorders
As treatment progresses, other professionals often help. These may include:
- Nurses
- Psychologist (pronounced - seye-KOL-uh-jist) - A professional who treats mental illness, emotional disturbance, and behavior problems. They use talk therapy as treatment, and cannot prescribe medication. A clinical psychologist will have a master's degree (M.A.) or doctorate (Ph.D.) in psychology, and possibly more training in a specific type of therapy.
- Occupational Therapist (pronounced - ok-yuh-PAY-shuh-nul) - A person qualified in the practice of occupational therapy, helping to restore a person's basic skills required by everyday life, such as bathing and dressing.
- Social Worker - A licensed clinical social worker (L.C.S.W.) is trained in psychotherapy and helps people with many different mental health and daily living problems to improve overall functioning. Usually has a master's degree in social work (M.S.W.).
- Nephrologist (pronounced - nuh-FROL-uh-jist) - A doctor who treats kidney diseases.
- Hematologist (pronounced - hee-muh-TOL-uh-jist) - A doctor specializing in blood disorders.
- Dermatologist (pronounced - dur-muh-TOL-uh-jist) - A doctor who treats skin problems and diseases.
- Neurologist (pronounced - noo-ROL-uh-jist) - A doctor specializing in disorders of the nervous system.
The range and effectiveness of treatments for lupus have increased dramatically, giving doctors more choices in how to manage the disease. It is important for the patient to work closely with the doctor and take an active role in managing the disease. Once lupus has been diagnosed, the doctor will develop a treatment plan based on the patient's age, sex, health, symptoms, and lifestyle. Treatment plans are tailored to the individual's needs and may change over time.
In developing a treatment plan, the doctor has several goals:
- To Prevent flares
- To treat symptoms when they occur
- To minimize organ damage and complications
The doctor and patient should reevaluate the plan regularly to ensure it is as effective as possible.
Your treatment might include using medicines to:
- Reduce swelling and pain
- Prevent or reduce flares
- Calm the immune system
- Reduce or prevent damage to the joints
- Reduce or prevent organ damage
Drugs play an important role in treating lupus. Most likely, the drugs prescribed to you will change often during your treatment.
Types of drugs commonly used to treat lupus include:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are used to reduce pain and swelling in joints and muscles. They can help with mild lupus - when pain isn't too bad and vital organs are not affected. Aspirin, ibuprofen, and naproxen are some over-the-counter NSAIDs sold in stores. You need a prescription from the doctor for stronger NSAIDs. NSAIDs may be used alone or in combination with other types of drugs to control pain, swelling, and fever. Even though some NSAIDs may be purchased without a prescription, it is important that they be taken under a doctor's direction. Common side effects of NSAIDs can include:- Stomach upset
- Heartburn
- Diarrhea
- Fluid retention
- Drowsiness
- Headache
- Corticosteroids
Corticosteroids (pronounced - KOR-tih-koh-STAIR-oyds) are related to cortisol, which is a natural anti-inflammatory hormone. They work by rapidly suppressing inflammation. Manmade versions are used to reduce swelling, tenderness, and pain in many parts of the body. In high doses, they can calm the immune system. Often, these drugs are called "steroids." They are different than steroids used by some people who play sports or lift weights.
Corticosteroids come as pills or liquids, creams to apply to the skin, and as a shot, such as prednisone (pronounced - PRED-nuh-sohn) (Deltasone ®), hydrocortisone, methylprednisolone (Medrol ®), and dexamethasone (Decadron ®, Hexadrol ®). Lupus symptoms tend to respond very quickly to these powerful drugs. Once this has happened, your doctor will want to lower your dose slowly until you no longer need it. The longer a person uses corticosteroids, the harder it becomes to lower the dose, and the greater the risk and severity of side effects. But stopping this medicine right away can harm your body. Make sure to use your medicine exactly as your doctor tells you to.
Sometimes doctors give very large amounts of corticosteroid by vein over a brief period of time (days) ("bolus" or "pulse" therapy). With this treatment, the typical side effects are less likely and slow withdrawal is unnecessary.
Researchers are working to develop ways to limit or offset the use of corticosteroids. For example, corticosteroids may be used in combination with other, less potent drugs, or the doctor may try to slowly decrease the dose once the disease is under control. People with lupus who are using corticosteroids should talk to their doctors about taking supplemental calcium and vitamin D or other drugs to reduce the risk of osteoporosis (weakened, fragile bones).
Corticosteriods can have many side effects, so your doctor will give you the lowest dose possible. Short-term side effects can include:- A round or puffy face
- Acne
- Heartburn
- Increased appetite
- Weight gain
- Mood swings
- Easy bruising
- Thinning skin and hair
- Stretch marks on the skin
- Weakened or damaged bones (osteoporosis and osteonecrosis)
- High blood pressure
- Damage to the arteries
- High blood sugar (diabetes)
- Infections
- Muscle weakness
- Cataracts
- Antimalarial Drugs
Antimalarial drugs are another type of drug commonly used to treat lupus. These drugs were originally used to treat malaria, but doctors have found that they also are useful for lupus. A common antimalarial used to treat lupus is hydroxychloroquine (pronounced - heye-DROK-see-KLOR-uh-kween) (Plaquenil ®). It may be used alone or in combination with other drugs and generally is used to treat fatigue, joint pain, skin rashes, and inflammation of the lungs. Another common antimalarial drug is chloroquine (pronounced - KLOR-uh-kween) phosphate (Aralen ® phosphate). Side effects of antimalarials can include:- Stomach upset
- Nausea
- Vomiting
- Diarrhea
- Headache
- Dizziness
- Blurred vision
- Trouble sleeping
- Itching
- And, extremely rarely, damage to the retina of the eye
Clinical studies have found that continuous treatment with antimalarials may prevent flares from recurring.
- Immunosuppressive Agents / Chemotherapy
For some patients whose kidneys or central nervous systems are affected by lupus, a type of drug called an immunosuppressive may be used. These drugs suppress the immune system to limit the damage to the organ. Examples are azathioprine (pronouncec - az-uh-THEYE-uh-preen) (Imuran ®), cyclophosphamide (pronouncec - seye-kluh-FOSS-fuh-myd) (Cytoxan ®), and mycophenolate mofetil (CellCept ®). These drugs may be given by mouth or by infusion (dripping the drug into the vein through a small tube). These drugs can cause serious side effects including:- Nausea
- Vomiting
- Hair loss
- Bladder problems
- Decreased fertility
- Increased risk of cancer and infection
- Other Therapies
In some patients, methotrexate (Folex ®, Mexate ®, Rheumatrex ®), a disease-modifying antirheumatic drug, may be used to help control the disease. - Alternative and Complementary Therapies
Because of the nature and cost of the medications used to treat lupus and the potential for serious side effects, many patients seek other ways of treating the disease. Some alternative approaches people have tried include special diets, nutritional supplements, fish oils, ointments and creams, chiropractic treatment, and homeopathy. Although these methods may not be harmful in and of themselves, and may be associated with symptomatic or psychosocial benefit, no research to date shows that they affect the disease process or prevent organ damage. Some alternative or complementary approaches may help the patient cope or reduce some of the stress associated with living with a chronic (lasting a long time) illness. If the doctor feels the approach has value and will not be harmful, it can be incorporated into the patient's treatment plan. However, it is important not to neglect regular health care or treatment of serious symptoms. An open dialogue between the patient and physician about the relative values of complementary and alternative therapies allows the patient to make an informed choice about treatment options.
Working closely with the doctor helps ensure that treatments for lupus are as successful as possible. Because some treatments may cause harmful side effects, it is important to report any new symptoms to the doctor promptly. Tell your doctor if your medicines no longer help your symptoms. Never stop or change treatments without talking to your doctor first.
Also, it is likely that you will need other drugs to treat conditions that are linked to your lupus - such as drugs to treat high blood pressure or osteoporosis. Never take vitamins or herbal supplements without talking to your doctor first. They might not mix well with medicines you use to treat lupus.
Tips for Working With Your Doctor
- Seek a health care provider who is familiar with SLE (Systemic Lupus Erythematosus) and who will listen to and address your concerns.
- Provide complete, accurate medical information.
- Make a list of your questions and concerns in advance.
- Be honest and share your point of view with the health care provider.
- Ask for clarification or further explanation if you need it.
- Talk to other members of the health care team, such as nurses, therapists, or pharmacists.
- Do not hesitate to discuss sensitive subjects (for example, birth control, intimacy) with your doctor.
- Discuss any treatment changes with your doctor before making them.
References:
1) The National Women's Health Information Center - U.S. Department of Health and Human Services - Office on Women's Health - May 2008 - www.4woman.gov
2) National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) - Information Clearinghouse - National Institutes of Health - Department of Health and Human Services - NIH Publication No. 03-4178 - September 1997 - Revised August 2003 - www.niams.nih.gov
This summary is a general overview about the topic discussed and does not include all the facts, or include everything there is to know about any medicine and/or products mentioned. Do not use any medicine and/or products without first talking to your doctor. Possible side effects of medications, other than those listed, may occur. Full Disclaimer & General Safety Advisory