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WHAT ARE SOME TREATMENTS FOR LUPUS?
Diagnosing and treating lupus are often a team effort between the patient and several types of health care professionals.
Just as no single factor has been shown to cause lupus, no one single treatment will be effective in treating lupus. Research indicates that lupus is caused by a combination of genetic, hormonal, and immune system factors. A predisposition to developing the disease does appear to be inherited.
Environmental factors including viral and bacterial infections to severe emotional stress or overexposure to sunlight, may play a role in provoking or triggering the disease. Certain drugs, such as the blood pressure drug hydralazine and the heart rhythm drug procainamide, may cause lupus-like symptoms. High estrogen levels resulting from pregnancy, estrogen replacement therapy, and oral contraceptives may aggravate lupus.
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 inflammatory disorders, often involving the immune
system). 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, 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 manage the disease. It is important for the patient to
work closely with the doctor and take an active role in managing the
disease. Once lupus has been diagnosed, the doctor will develop a
treatment plan based on the patient's age, sex, health, symptoms, and
lifestyle. Treatment plans are tailored to the individual's 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 it is as effective as
people with joint or chest pain or fever, drugs that decrease
inflammation, called nonsteroidal anti-inflammatory drugs (NSAIDs), are
often used. While some NSAIDs, such as ibuprofen and naproxen, are
available over the counter, a doctor's 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 doctor's direction. Common side effects of NSAIDs can include
stomach upset, heartburn, diarrhea, and fluid retention. Some people
with lupus also develop liver, kidney, or even neurological
complications, making it especially important to stay in close contact
with the doctor while taking these medications.
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. 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 anti-malarials can include
stomach upset and, extremely rarely, damage to the retina of the eye.
* 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
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, and
weight gain. These side effects generally stop when the drug is stopped.
It is 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
Long-term side effects of
corticosteroids can include stretch marks on the skin, weakened or
damaged bones (osteoporosis and osteonecrosis), high blood pressure,
damage to the arteries, high blood sugar (diabetes), infections, and
cataracts. Typically, the higher the dose and the longer they are taken,
the greater the risk and severity of side effects. Researchers are
working to develop ways 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).
For some patients whose kidneys or central nervous systems are affected
by lupus, a type of drug called an immunosuppressive may be used.
Immunosuppressives, such as cyclophosphamide (Cytoxan) and mycophenolate
mofetil (CellCept), restrain the overactive immune system by blocking
the production of immune cells. 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.
In some patients, methotrexate (Folex, Mexate, Rheumatrex), a
disease-modifying antirheumatic drug, may be used to help control the
disease. 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.
Alternative and Complementary Therapies: Because of the nature and cost of the medications used to treat lupus and the potential for serious side effects, many patients seek other ways of treating the disease. Some alternative approaches people have tried include special diets, nutritional supplements, fish oils, ointments and creams, chiropractic treatment, and homeopathy. Although these methods may not be harmful in and of themselves, and may be associated with symptomatic or psychosocial benefit, no research to date shows that they affect the disease process or prevent organ damage. Some alternative or complementary approaches may help the patient cope or reduce some of the stress associated with living with a chronic illness. If the doctor feels the approach has value and will not be harmful, it can be incorporated into the patient's treatment plan. However, it is important not to neglect regular health care or treatment of serious symptoms. An open dialogue between the patient and physician about the relative values of complementary and alternative therapies allows the patient to make an informed choice about treatment options.
Also of interest to the lupus sufferer: Rosacea-Ltd III is a great way to beautify your rosacea-affected skin.