Lupus (Systemic Lupus Erythematosus) (cont.)

Medical Author:

William C. Shiel Jr., MD, FACP, FACR

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.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

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.

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Medical Editor:

Catherine Burt Driver, MD

Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

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Medical Treatment

Ibuprofen (Motrin, Advil) and other nonsteroidal anti-inflammatory drugs are used to reduce inflammation. Ibuprofen and similar drugs can harm kidney function, especially in people who already have kidney problems.
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 [BLyS]) 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).
Steroids are used to rapidly reduce inflammation when necessary.

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 weeks. Your health care professional 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.

Complications of Lupus»

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Glossary

Lupus (Systemic Lupus Erythematosus) Topic Guide

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