Treatments for Lupus


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Treatment list for Lupus: The list of treatments mentioned in various sources for Lupus includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Treatment of Lupus: medical news summaries: The following medical news items are relevant to treatment of Lupus:

Treatments of Lupus discussion: There is no cure for lupus. Treatment is symptomatic. With a combination of medication, rest, exercise, proper nutrition, and stress management, most individuals with lupus can often achieve remission or an amelioration of symptoms that improves their quality of life. Medications used in the treatment of lupus may include aspirin and other nonsteroidal anti-inflammatory drugs, antimalarials, corticosteroids, and other immunosuppressants. 1

Remember that each person has different symptoms. Treatment depends on the symptoms. The doctor may give you aspirin or a similar medicine to treat swollen joints and fever. Creams may be prescribed for a rash. For more serious problems, stronger medicines such as antimalaria drugs, corticosteroids, and chemotherapy drugs are used. Your doctor will choose a treatment based on your symptoms and needs.

Always tell your doctor if you have problems with your medicines. Let your doctor know if you take herbal or vitamin supplements. Your medicines may not mix well with these supplements. You and your doctor can work together to find the best way to treat all of your symptoms. 2

At present, there is no cure for lupus. However, lupus can be very successfully treated with appropriate drugs, and most people with the disease can lead active, healthy lives. Lupus is characterized by periods of illness, called flares, and periods of wellness, or remission. Understanding how to prevent flares and how to treat them when they do occur helps people with lupus maintain better health. 3

Diagnosing and treating lupus is often a team effort between the patient and several types of health care professionals. A person with lupus can go to his or her family doctor or internist, or can visit a rheumatologist. A rheumatologist is a doctor who specializes in rheumatic diseases (arthritis and other diseases of the joints, bones, and muscles). Clinical immunologists (doctors specializing in immune system disorders) may also treat people with lupus. As treatment progresses, other professionals often help. These may include nurses, psychologists, social workers, and specialists such as nephrologists (doctors who treat kidney disease), hematologists (doctors specializing in blood disorders), dermatologists (doctors who treat skin disease), and neurologists (doctors specializing in disorders of the nervous system).

The range and effectiveness of treatments for lupus have increased dramatically, giving doctors more choices in how to treat the disease. It is important for the patient to work closely with the doctor and take an active role in treatment. Once lupus has been diagnosed, the doctor will develop a treatment plan based on the patientís age, sex, health, symptoms, and lifestyle. Treatment plans are tailored to the individualís needs and may change over time. In developing a treatment plan, the doctor has several goals: to prevent flares, to treat them when they do occur, and to minimize organ damage and complications. The doctor and patient should reevaluate the plan regularly to ensure that it is as effective as possible.

Several types of drugs are used to treat lupus. The treatment the doctor chooses is based on the patientís individual symptoms and needs. For people with joint or chest pain or fever, drugs that decrease inflammation, referred to as nonsteroidal anti-inflammatory drugs (NSAIDs), are often used. While some NSAIDs are available over the counter, a doctorís prescription is necessary for others. NSAIDs may be used alone or in combination with other types of drugs to control pain, swelling, and fever. Even though some NSAIDs may be purchased without a prescription, it is important that they be taken under a doctorís direction. Common side effects of NSAIDs, including those available over the counter, can include stomach upset, heartburn, diarrhea, and fluid retention. Some patients with lupus also develop liver and kidney inflammation while taking NSAIDs, making it especially important to stay in close contact with the doctor while taking these medications.

A new class of anti-inflammatory drugs called COX-2 inhibitors (celecoxib [Celebrex]; rofecoxib [Vioxx]; mobic [Meloxicam]) have all of the same effects as NSAIDs on pain and inflammation but have a much lower risk of significant gastrointestinal side effects. These agents have not been extensively studied in patients with lupus and have not been approved by the Food and Drug Administration for use specifically in lupus. However, they might provide benefits similar to NSAIDs.

NSAIDs Used To Treat Lupus*

Generic Name

Ibuprofen
Naproxen
Sulindac
Diclofenac
Piroxicam
Ketoprofen
Diflunisal
Nabumetone
Etodolac
Oxaprozin
Indomethacin

Brand Name

Motrin, Advil
Naprosyn, Aleve
Clinoril
Voltaren
Feldene
Orudis
Dolobid
Relafen
Lodine
Daypro
Indocin

* Brand names included in this publication are provided as examples only and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Antimalarials are another type of drug commonly used to treat lupus. These drugs were originally used to treat malaria, but doctors have found that they also are useful for lupus. Exactly how antimalarials work in lupus is unclear, but scientists think that they may work by suppressing parts of the immune response. A common antimalarial used to treat lupus is hydroxychloroquine (Plaquenil). It may be used alone or in combination with other drugs and generally is used to treat fatigue, joint pain, skin rashes, and inflammation of the lungs.

Clinical studies have found that continuous treatment with antimalarials may prevent flares from recurring. Side effects of antimalarials can include stomach upset and, extremely rarely, damage to the retina of the eye.

The mainstay of lupus treatment involves the use of corticosteroid hormones, such as prednisone (Deltasone), hydrocortisone, methylprednisolone (Medrol), and dexamethasone (Decadron, Hexadrol). Corticosteroids are related to cortisol, which is a natural anti-inflammatory hormone. They work by rapidly suppressing inflammation. Corticosteroids can be given by mouth, in creams applied to the skin, or by injection. Because they are potent drugs, the doctor will seek the lowest dose with the greatest benefit. Short-term side effects of corticosteroids include swelling, increased appetite, weight gain, and emotional ups and downs. These side effects generally stop when the drug is stopped. It can be dangerous to stop taking corticosteroids suddenly, so it is very important that the doctor and patient work together in changing the corticosteroid dose. Sometimes doctors give very large amounts of corticosteroid by vein over a brief period of time (days) ("bolus" or "pulse" therapy). With this treatment, the typical side effects are less likely and slow withdrawal is unnecessary.

Long-term side effects of corticosteroids can include stretch marks on the skin, excessive hair growth, weakened or damaged bones (osteoporosis and osteonecrosis), high blood pressure, damage to the arteries, high blood sugar, infections, and cataracts. Typically, the higher the dose of prolonged corticosteroids, the more severe the side effects. Also, the longer they are taken, the greater the risk of side effects. Researchers are working to develop alternative strategies to limit or offset the use of corticosteroids. For example, corticosteroids may be used in combination with other, less potent drugs, or the doctor may try to slowly decrease the dose once the disease is under control. People with lupus who are using corticosteroids should talk to their doctors about taking supplemental calcium and vitamin D or other drugs to reduce the risk of osteoporosis (weakened, fragile bones).

In special circumstances, patients may require stronger drugs to combat lupus symptoms. In some patients, methotrexate (Folex, Mexate, Rheumatrex) may be used to help control the disease. Patients who have many body systems affected by the disease may receive intravenous gamma globulin (Gammagard S/D), a blood protein that increases immunity and helps fight infection. Gamma globulin also may be used to control acute bleeding in patients with thrombocytopenia or to prepare a person with lupus for surgery.

For patients whose kidneys or central nervous systems are affected by lupus, a type of drug called an immunosuppressive may be used. Immunosuppressives, such as azathioprine (Imuran) and cyclophosphamide (Cytoxan), restrain the overactive immune system by blocking the production of some immune cells and curbing the action of others. These drugs may be given by mouth or by infusion (dripping the drug into the vein through a small tube). Side effects may include nausea, vomiting, hair loss, bladder problems, decreased fertility, and increased risk of cancer and infection. The risk for side effects increases with the length of treatment. As with other treatments for lupus, there is a risk of relapse after the immunosuppressives have been stopped.

Working closely with the doctor helps ensure that treatments for lupus are as successful as possible. Because some treatments may cause harmful side effects, it is important to report any new symptoms to the doctor promptly. It is also important not to stop or change treatments without talking to the doctor first. 3

Anti-inflammatory drugs can help control arthritis symptoms; skin lesions may respond to topical treatment such as corticosteroid creams. Oral steroids, such as prednisone, are used for the systemic symptoms. Wearing protective clothing and sunscreen when outdoors is recommended. 4

Because each person's symptoms are different, doctors treat lupus on an individual basis. Once lupus has been diagnosed, the doctor will develop a treatment plan based on the patient's age, gender, health, symptoms, and lifestyle. Tailored to the individual's needs, this plan may change over time. In developing a treatment plan, the doctor has several goals: to prevent flares, to effectively treat them when they do occur, and to minimize complications. The doctor and patient should reevaluate the plan regularly to ensure that it is as effective as possible.

Treatment for lupus includes physical and emotional rest, protection from direct sunlight, a healthful diet, exercise, prompt treatment of infections, avoidance of known allergens and aggravating factors, and medication when necessary. The medication the doctor chooses is based on the patient's individual symptoms and needs. For people with joint pain, fever, and swelling, drugs that decrease inflammationCnonsteroidal anti-inflammatory drugs (NSAIDs)Care often used. Antimalarials are another type of drug commonly used to treat lupus. They may be used alone or in combination with other drugs to treat fatigue, joint pain, skin rashes, and inflammation of the lungs. Corticosteroid hormones are the mainstay of lupus treatment. Related to cortisol, which is a natural anti-inflammatory hormone, corticosteroids work by rapidly suppressing inflammation. Because they are potent drugs, the doctor will seek the lowest dose with the greatest benefit.5

Because the signs of lupus often differ from one person to another, treatment, too, may vary. There is no known cure today for lupus. However, in many cases, symptoms of the disease can be relieved. The doctor may recommend aspirin or similar medication to treat the painful, swollen joints and the fever. Creams may be prescribed for the rash, and stronger medicines prescribed for more serious problems. The good news is that with the correct medicine and by taking care of themselves, most lupus patients can hold jobs, have children, and lead full lives. 6

Footnotes:
1. excerpt from NINDS Neurological Sequelae Of Lupus Information Page: NINDS
2. excerpt from The Many Shades of Lupus: NIAMS
3. excerpt from Handout on Health Systemic Lupus Erythematosus: NIAMS
4. excerpt from Connective Tissue Diseases: NWHIC
5. excerpt from Lupus Fact Sheet: NWHIC
6. excerpt from Lupus: NWHIC

Last revision: June 2, 2003

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