Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
For a person known to have lupus and already taking medications for it, every effort will be made in the emergency department to avoid the addition of potentially dangerous medications with significant side effects.
The use of ibuprofen (Motrin, Advil) and medications like ibuprofen in treating lupus requires some caution. Ibuprofen and similar drugs can harm kidney function, especially in people who already have kidney problems. In addition, ibuprofen and related agents can rarely cause inflammation of the lining of the brain resulting in a severe headache.
Many people with lupus can experience significant relief of their symptoms without the use of steroids or other immune-suppressing agents (such as azathioprine
[Azasan, Imuran] or cyclophosphamide [Cytoxan, Cytoxan Lyophilized, Neosar]). However, certain acute complications (such as acute kidney failure) caused by lupus may require high doses of oral or intravenous steroids along with other immune-suppressive drugs. Some people will require long-term treatment with steroids and immune-suppressing agents.
Antimalarial drugs such as hydroxychloroquine and chloroquine are excellent alternatives for people with lupus who do not respond well to ibuprofen or aspirin (Bayer Aspirin, Bufferin, Ecotrin). Many people on antimalarial drugs experience significant relief of their symptoms, especially rashes, fatigue, and joint and muscle pains. Hydroxychloroquine has been shown to decrease the frequency of flares in patients with systemic lupus erythematosus. Based on these data, it is widely believed that all patients should be treated with hydroxychloroquine indefinitely, unless they develop adverse effects. However, with antimalarial
drug use, careful periodic evaluation of the eyes is required to prevent serious complications.
A new B-cell-suppressing treatment is belimumab (Benlysta). Belimumab blocks the stimulation of the B cells (a B-lymphocyte stimulator or BLyS-specific inhibitor) and is indicated for the treatment of adult patients with active, autoantibody-positive systemic lupus erythematosus who are receiving standard therapy. It is important to note that the efficacy of belimumab has not been evaluated in patients with severe active central nervous system lupus or severe active lupus nephritis.
Belimumab has not been studied in combination with intravenous cyclophosphamide or other biologic therapies.
Some patients can benefit from dietary treatment with food supplementation with dehydroepiandrosterone (DHEA) over the counter. On the contrary, patients with autoimmune diseases, including lupus, should not take "immune booster" supplements such as echinacea.
For people with sun-sensitive lupus rashes,
appropriate use of ultraviolet-blocking sunscreens and protective clothing is
critical. Heat, infrared light, and, rarely, fluorescent light can also bring
on flares. Topical steroid creams are also helpful for lupus-associated rashes, once they develop. A doctor should closely monitor extended use of steroid creams, especially on the face and covered areas.
Treatment of seizures or psychiatric disturbances usually involves therapy directed at the type of disturbance itself (the use of anticonvulsants for seizures, for example, and the use of antidepressants for severe depression).
Steroid use is associated with a number of complications, including psychiatric disturbances, increased susceptibility to infection, fragile bones, cataract formation, diabetes and worsening of existing diabetes, high blood pressure, thinning of the skin, puffiness of the face, and avascular necrosis of joints. Steroids are often reserved for lupus patients with serious organ involvement or lupus that does not respond to other medications.
An important side effect of steroids and other immune-suppressing agents is an increase in the susceptibility to dangerous infections.
In pregnancy, the preferred steroid for the treatment of lupus is
prednisone (Meticorten, Sterapred, Sterapred DS) because it crosses into the fetus much less than other steroid agents.
Steroids should not be stopped abruptly if you have been taking them for more than several months. Your health-care practitioner will direct you how to taper the medicine.
If blood clots form spontaneously in the body, treatment with an agent that prevents clot formation is critical. For this reason, use of heparin or warfarin (Coumadin) is advised. In pregnancy, heparin is the agent of choice because of the adverse fetal effects of warfarin.
