Lupus Erythematosus.
Last updated Thursday, December 23, 2004
Management and treatmentHow is lupus erythematosus treated? The treatment program for lupus includes taking medications, getting
rest when the disease is active, and being careful about sun exposure.
Lupus is an unpredictable disease. Signs of the disease appear and
disappear, sometimes for no apparent reason. Because lupus assumes so
many different forms, finding the right balance of treatment for you
may take time--but it is very important.
Once an effective treatment program has been started, continue it
faithfully. If your symptoms change, let your doctor know so that you
can work together to modify your program.
If you tire easily, you need a balance of rest and activity. Part of
this balancing includes pacing yourself during the day, and also from
day to day. Allow plenty of time to finish the things you start, so you
won't feel rushed. Don't try to do too much at one time. Be realistic.
Scheduling and pacing also includes doing the hardest things when
you're feeling your best.
It's usually not necessary to give up your normal activities.
However, you may need to limit tiring activities, especially if you
feel a flare coming on. A flare is a period during which disease
symptoms appear or become worse. During a flare, don't hesitate to ask
others in the family to help out more at home. You might consider
getting someone to come in to help you with housework.
While on the job, try to take short breaks and alternate activities.
You might need to cut down on the number of hours you work. If cutting
down your hours presents a problem with your current job, a vocational rehabilitation counselor may be able to help you get a job which allows more flexible hours or is less physically demanding. Can diet help treat lupus erythematosus? Eating a balanced diet
is an important part of the treatment plan. At times when your lupus is
active or your appetite is poor, it may be helpful to take a daily
multivitamin. Your doctor may prescribe special vitamins such as folic
acid for specific lupus problems. It is important to remember, however,
that excessive doses of vitamins can have serious side effects. You
should be sure that your doctor is aware of any vitamin preparations
you take.
At times you may be placed on a special diet because of problems
caused by features of your lupus such as kidney disease. A low salt
diet will help to prevent the accumulation of edema fluid. When the
kidneys do not function normally, it may be necessary to limit the
amount of protein in the diet.
Some scientists have suggested that diets rich in fish oil may have
a beneficial effect on the course of lupus by preventing inflammation
from developing. Clinical trials of fish oil in people with lupus are
still in the early stages. Can exercise, therapy, rest, posture, or stretching help treat lupus erythematosus? It is equally important to do proper exercises
on a daily basis. This may be easier to do when the disease is not in
an active stage and you are feeling better. However, even during a
flare, doing gentle range of motion and strengthening exercises is
important to keep you from getting stiff. Exercise can also help you
avoid muscle weakness. Working under your doctor's guidance, a physical
therapist can help you set up an exercise program that fits your
schedule and physical condition.
What medications are used to treat or manage lupus erythematosus? Medication is a necessary part of treatment for most people with lupus.
Because of the changing character of lupus, the type and amount of
drugs may be changed often. Changing how much medicine you take or how
often you take it is a decision to be made only after talking with your
doctor, however. Changing the schedule on your own, or not taking any
drug your doctor has prescribed, could have harmful effects. It will
also make it more difficult for your doctor to evaluate the course of
your disease and the effectiveness of the medication. If you start
taking a drug without medical advice, it could cause you harm, either
by interacting with other medications prescribed for you, or by causing
side effects which might even mimic some of the symptoms of your lupus.
Aspirin and other anti-inflammatory drugs
Aspirin
is sometimes the only medication the doctor will prescribe. Because
aspirin is commonly used for minor problems, you may not think it is
special enough. However, aspirin is more than a painkiller. It is also
an anti-inflammatory drug, which makes it helpful in treating the joint
discomfort of lupus. But it can only do its job if you take it exactly
as directed. This may mean taking it at regular internals, and often in
large doses.
Some people are bothered by stomach problems when taking high
doses of aspirin. One way to lessen this problem is to take the tablets
with a meal or with milk. You might try using enteric-coated aspirin
tablets. These do not dissolve until they have passed through the
stomach. Another approach is to take antacids about one-half hour after
meals and at bedtime to help protect the lining of your stomach.
Non-steroidal anti-inflammatory drugs (NSAIDs)
have properties similar to aspirin. Some examples of brand name NSAIDs
are Clinoril, Feldene, Indocin, Meclomen, Motrin, Rufen, Nalfon,
Naprosyn, Orudis and Tolectin. In addition to these prescription-only
medications, ibuprofen may be obtained over-the-counter. For some
people, these drugs may be more effective or better tolerated than
aspirin. They all have the potential for causing stomach irritation,
and some may cause specific side effects such as dizziness or diarrhea.
Some NSAIDs are quite long-acting, which may be an important
consideration in finding a regimen that compliments your lifestyle.
Aspirin and most NSAIDs can damage the liver. NSAIDs may also
cause an alteration in kidney function. Usually, however, the damage
can be reversed when the medication is stopped or given in smaller
doses.
Antimalarial drugs
Some doctors prescribe drugs similar to quinine which are
used to treat malaria. The most commonly used antimalarial drug in
lupus is Plaquenil. There is no known relationship between lupus and
malaria, and no one knows just how the antimalarial drugs work in
lupus. They are, however, helpful in treating discoid lupus and some of
the manifestations of systemic lupus, especially fever, joint pains and
pleuritis (inflammation of the lining of the lungs). These drugs
increase resistance to sun exposure and can help to prevent lupus
rashes and systemic problems if you are exposed to ultraviolet light.
The most common side effects are mild nausea, vomiting and diarrhea.
Although it is rare, sometimes antimalarial drugs can affect
your eyes if taken in large doses for a long time. If you are taking
these drugs, you need to have regular eye examinations by an
ophthalmologist, a medical doctor specializing in eye care. If you
notice any changes in vision such as blurring or blind spots, contact
your doctor right away for advice.
Corticosteroids
Corticosteroids,
or cortisone-like drugs, are commonly used in the treatment of severe
lupus. They are synthetic forms of hormones naturally produced by your
adrenal glands, which are located on top of your kidneys.
Corticosteroids are the strongest anti-inflammatory drugs
available. They can dramatically reduce pain and inflammation in a
matter of hours. They also can control many of the signs and symptoms
of lupus.
It is common for a doctor to prescribe high doses of
corticosteroids when your lupus is very active, and especially when it
affects your kidneys or nervous system. Pulse steroids may be
prescribed at such times. This means that a very high dose of steroid
is given directly into the veins, usually every day for a three-day
period. As the symptoms and abnormal laboratory tests improve, the
steroid dose is usually tapered slowly over a period of months. For
some people, an alternate, or every other day, dose of steroids may be
prescribed. This method of taking steroids may help to decrease some of
the side effects of the drug. If you have skin rashes, you may be given
creams or ointments containing corticosteroids.
Common side effects of the cortisone-like drugs include
weight gain, rounding of the face and easy bruising. Large doses of
corticosteroids may cause mood swings from extreme nervousness and
insomnia to depression. Other serious effects include the development
of fluid retention with swelling of the legs and high blood pressure,
the triggering or worsening of diabetes, an increase in the risk of
infection and rarely, bleeding from the stomach. Use of corticosteroids
over a long period of time may lead to thinning of the bones (osteoporosis), and to cataracts.
If you are taking these powerful drugs, be sure to inform any doctor or
dentist before you have surgery or undergo any other type of stressful
procedure. Your body may need more steroids at such times.
NEVER change your dose of corticosteroids without first
discussing it with your doctor. Stopping them or changing the dose
quickly may make you very ill.
Immunosuppressive drugs
Immunosuppressive drugs are used to treat autoimmune
diseases. They weaken the body cells that produce the immune and
inflammatory responses. Immunosuppressive drugs are used only with
active disease, especially with severe kidney problems. They are almost
always taken along with corticosteroids, to treat people who have not
responded to other types of drug therapy. They may also be used to help
in cutting down the dose of corticosteroids.
The most commonly used immunosuppressive drugs are Imuran and
Cytoxan. Chlorambucil, Methotrexate and a new immunosuppressive drug
Cyclosporine, which is also given to people with kidney transplants,
may be occasionally prescribed.
These drugs can have serious side effects. If you are taking
an immunosuppressive, regular blood tests will be done because the drug
can interfere with the formation of blood cells. The development of
infection is also more likely when you are taking an immunosuppressive,
so it is important to notify your doctor if you develop a fever or any
other new symptoms.
Sometimes, even with the use of corticosteroids and
immunosuppressive drugs, the kidneys fail. Fortunately, dialysis is
available to cleanse waste products from the blood. The most common
form of dialysis is hemodialysis, in which catheters are placed in an
artery and vein, and the blood is run through a cleansing machine.
When kidney failure is permanent, kidney transplantation may
be performed. This procedure can often allow a person with lupus to
return to a normal lifestyle, even though medication is generally
required to prevent rejection of the new kidney.
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