Lupus

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Treatment

There is no cure for lupus, and the goals of treatment are to minimize symptoms, to reduce inflammation in the body, and to maintain function. Because the course of the disease varies from patient to patient, there are a number of different treatment plans. In many cases, preventative treatment can reduce the frequency and severity of flares (periods of worsening symptoms).

It is important for patients with lupus to avoid excessive sun exposure, wear sunscreen regularly, and avoid taking Echinacea (herb that stimulates the immune system).

It also is recommended that patients:

• Avoid smoking
• Have regular medical checkups
• Limit alcohol intake
• Take medication as prescribed

In most cases, women with lupus are unable to tolerate oral contraceptives (birth control pills) or estrogen replacement therapy (ERT). Sulfonamide, which is present in some antibiotics, also has been shown to cause flares in patients with SLE.

Medications
The types of medications used to treat lupus depend on which organs are affected and on the severity of symptoms. Medications that are commonly used include the following:

• Non-steroidal anti-inflammatory drugs (NSAIDs; e.g., aspirin, ibuprofen [Advil®, Motrin®], naproxen [Naprosyn®], indomethacin [Indocin®])
• Acetaminophen (e.g., Tylenol®)
• Corticosteroids (e.g., Prednisone®)
• Antimalarials (e.g., chloroquine [Aralen®], hydroxychloroquine [Plaquenil®])
• Immunomodulating drugs (e.g., azathioprine [Imuran®], cyclophosphamide [Neosar®])

NSAIDs are used to treat muscle and joint pain and inflammation. These drugs may cause gastrointestinal side effects (e.g., stomach pain, gastrointestinal bleeding) and should be taken with meals. Antacids and other medications, such as Cytotec® and the newer drug Arthrotec® may further reduce the risk for these side effects.

Corticosteroids, which are hormones that reduce inflammation and suppress the immune system, cause a number of side effects (e.g., weight gain, high blood pressure, risk for infection). It is important to regulate the dose of these medicines to maximize the benefit and reduce the risk for adverse effects. The risks are higher when the medication is taken for a long period of time or at high doses.

Antimalarials may be prescribed for skin and joint symptoms of lupus. These medications rarely cause side effects, but they may affect the eyes. Patients who are taking antimalarials should have their eyes examined regularly (every 6 months to 1 year).

Immunomodulating drugs are immunosuppressive medications that reduce inflammation and suppress the immune system. Side effects include anemia (low red blood cell count), low white blood cell count, and an increased risk for infection. Patients using these drugs may also develop a predisposition to cancer in the future.

Intravenous immunoglobulin injections, which block production of specific antibodies, may be given to lupus patients on a regular basis to increase platelets (blood cells that aid in coagulation).

Other Treatments
If the kidneys are involved, a biopsy (surgical removal of a small piece of tissue for microscopic evaluation) is performed to determine what type of disease process is occurring. This information is necessary to develop the correct treatment plan.

If renal failure occurs, hemodialysis is the preferred treatment over peritoneal dialysis. Patients who experience kidney failure can be considered for renal transplant because the risk for development of the disease in the transplanted kidney is low.

Severe cases of inflammation in and around the lungs and heart may require surgical drainage, especially if fluid surrounding the heart decreases its ability to pump blood (called cardiac tamponade).

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