Lupus; Treatment.

If diagnosed at an early stage, treated promptly and monitored routinely, systemic lupus erythematosus (SLE) is rarely fatal. You should make sure that every health care professional you deal with knows you have lupus.

Whether your disease is mild or severe, you have to stay under close medical supervision. You should let your health care professionals know immediately if you suffer any injuries, get sick or plan to become pregnant because many things may cause your disease to flare.

Typical warning signs of a flare are:

increased fatigue, malaise and muscle aches (like the flu)

a new or higher fever

increased pain or swelling in the joints, especially when you wake up

development or worsening of a rash, particularly one that is made worse by the sun

shortness of breath or pain when breathing

Keep an open dialogue with a health care professional whom you trust and can easily reach in an emergency. If you are experiencing a flare, it might be important to receive diagnostic tests, change medications or postpone certain elective procedures or surgeries.

Although a lupus pregnancy is considered high risk, many women with lupus can carry their babies safely to the end of the term if they plan the pregnancy with the help of a rheumatologist and receive care from an experienced high-risk obstetrical team. Women with lupus have a higher rate of miscarriage and premature births compared to women without the disease. Currently, more than half of women with lupus have pregnancies that are completely normal, 25 percent deliver healthy babies prematurely, and 20 percent experience miscarriage or death of a baby. Those with antiphospholipid antibodies have a much higher risk of developing preeclampsia, a form of dangerously high blood pressure that increases the risk of miscarriage, low birthweight babies, premature births and injury to the mother. These complications sometimes occur in women with lupus who are not known to have antiphospholipid antibodies.

Several over-the-counter and prescription medications are available to manage lupus symptoms including:

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, as well as aspirin.

Corticosteroids. These drugs, including prednisone (Deltasone), prednisolone (Prelone), hydrocortisone (Cortef, Cortaid) and methylprednisolone (Medrol), suppress the immune system and reduce inflammation. They can be taken orally, given through injection or used in cream formulations to treat skin lesions. However, they can lead to numerous side effects, including acne, weight gain, diabetes, cataracts, cardiovascular problems and heightened susceptibility to infections. People with lupus are especially prone to weakened or damaged bones, a side effect of high-dose or long-term corticosteroid treatment. People with lupus who take corticosteroids should talk to their health care professionals about taking vitamin D, calcium or other treatments to prevent osteoporosis.

Antimalarial drugs, such as hydroxychloroquine sulfate (Plaquenil) and chloroquine (Aralen), can control a variety of lupus systems including arthritis, skin rashes, mouth ulcers, lung rashes, fatigue and fever. They promote healthy blood vessels and have an anti-inflammatory effect. Side effects of antimalarials include nausea or diarrhea and, in rare cases, damage to the retina of the eye. A person taking antimalarial treatment should be examined by an eye doctor every six months to a year to prevent unnecessary optical damage. The beneficial effects of these treatments on symptoms are often slow at the beginning. It may take weeks or months for these medications to make an impact.

Other agents like methotrexate (Folex, Mexate, Rheumatrex), azathioprine (Asasan), mycophenolate mofetil (Cellcept), leflunamide (Arava) and cyclosporine (Sandimmune, Neoral) are sometimes used to control symptoms of lupus. These are immunomodulating drugs, and they have some side effects, such as nausea, diarrhea, mouth ulcers, rashes, liver toxicity and bone marrow suppression, usually leading to low white blood cell counts. Methotrexate can cause inflammatory damage to the lung or liver, and in the case of cyclosporine, there is a potential for kidney damage.

Chemotherapy. Under some circumstances, chemotherapeutic drugs such as cyclophosphamide (Cytoxan) may be used to suppress the immune system and inflammation. Cyclophosphamide can be used safely, with care, but can have significant side effects, including gastrointestinal complications, hair loss and greater risk of infection.

References

The Lupus Foundation of America. 2008. http://www.lupus.org. Accessed June 2008.

"Lupus Causes." The Mayo Clinic. October 2007. http://www.mayoclinic.com. Accessed February 2008.

"Medicines." The Lupus Foundation of America. 2008. http://www.lupus.org. Accessed February 2008.

"COX-2 Selective and Non-Selective Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)." U.S. Food and Drug Administration Center for Drug Evaluation and Research. http://www.fda.gov. Updated April 15, 2005. Accessed June 3, 2005.

"FDA Issues Public Health Advisory on Vioxx as its Manufacturer Voluntarily Withdraws Its Product." U.S. Food and Drug Administration. http://www.fda.gov. Accessed October 1, 2004.

Lupus Foundation of America. http://www.lupus.org. Accessed June 8, 2004.

http://www.lupus.org. Accessed June 8, 2004.

http://clinicalstudies.info.nih.gov. Accessed June 8, 2004.

"Lupus: A Patient Care Guide for Nurses and Other Health Care Professionals." erythematosus." National Institute of Arthritis and Musculoskeletal and Skin Diseases. May 2001. http://www.niams.nih.gov. Accessed June 8, 2004.

"Handout on Health: Systemic Lupus Erythematosus." National Institute of Arthritis and Musculoskeletal and Skin Diseases. Revised August 2003 http://www.niams.nih.gov. Accessed June 8, 2004.

"Patient Information Sheet #1: Living With Lupus." National Institute of Arthritis and Musculoskeletal and Skin Diseases. May 2001. http://www.niams.nih.gov. Accessed June 8, 2004.

"Treatment." Lupus Foundation of America. http://www.lupus.org. Accessed June 8, 2004

"Lupus is a Significant Health Issue for Women and People of Color." May 2001. The National Women's Health Information Center. http://www.4woman.gov. Accessed June 8, 2004.

"Drugs Approved by the FDA: Drug Name: Mobicr (meloxicam) Tablets" CenterWatch Clinical Trials Listing Service. Updated Nov. 14 2000. http://www.centerwatch.com. Acessed June 8, 2004.

"Targets for New SLE Treatments" Division of Rheumatology of The Hospital for Special Surgery. January 2002. http://rheumatology.hss.edu. Accessed June 8, 2004.

Keywords: lupus, systemic lupus erythematosus, sle, pregnant, symptoms, miscarriage, pregnancy, medications, side effects, immune system, suppress the immune system, antimalarial, premature birth, flare, treatment, nsaid, nsaids