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Lupus (Systemic Lupus Erythematosus) (cont.)

Medical Treatment

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.

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 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 (Hep-Lock, Hep-Pak CVC, Heparin Lock Flush) or warfarin (Coumadin) is advised. In pregnancy, heparin is the agent of choice because of the adverse fetal effects of warfarin.