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Lupus Treatments
There is no cure for Lupus, but by working closely
with their physicians most Lupus patients can maintain a fairly
normal life. There are some
treatments
aimed at preventing flares and minimizing disease activity while
others are used to treat or relieve
symptoms.
Below is some of the more common
treatments
as well as the common side effects associated with them.
We have also listed some of the
medications
used to treat Lupus with the brand names in
parenthesis.
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Rest - Proper rest is possibly the
most important thing all Lupus patients need. Too much or
too little can exacerbate Lupus and it's
symptoms.
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Sun Avoidance - It is important for Lupus
patients, especially photosensitive ones, to avoid the sun when
they can. Ultraviolet light can cause or worsen rashes and Lupus
flares. When sun can not be avoided, Lupus patients should
always wear sun block that protects against UVA & UVB rays and protective clothing.
Tanning beds and unfiltered fluorescent light bulbs also emit
ultraviolet light and can worsen
Lupus
symptoms.
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Exercise - Regular exercise can prevent
muscle weakness and fatigue.
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Diet and Nutrition - It is important that
Lupus patients maintain proper diet and nutrition to keep their
bodies as healthy as possible to help fight infection as well as
the Lupus itself. There are some foods that have been
known to cause Lupus symptoms alfalfa sprouts are number one on
the list. A low sodium diet is recommended for patients
with kidney involvement.
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Immunizations - It is important for Lupus
patients to be immunized to prevent infections which can cause
flares. Patients on immunosuppressives should not get live
vaccines.
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Non-Steroidal Anti-Inflammatory Drugs
(NSAIDs) - These medications are used to
treat
muscle and joint pain by reducing
inflammation caused by a variety of rheumatic diseases,
including SLE. Examples of such drugs are acetylsalicylic acid
(e.g., aspirin), ibuprofen (Motrin), naproxen (Naprosyn),
Etodolac (Lodine), nabumetone (Relafen) and several others.
Side effects include upset stomach, heartburn or ulcer, kidney
damage, increased risk for heart attack and stroke.
Patients with kidney involvement may need to avoid NSAIDs.
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Antimalarials - Antimalarials like
Chloroquine (Aralen) or hydroxychloroquine (Plaquenil) are often
prescribed to Lupus patients, particularly ones with skin or
joint
symptoms.
Antimalarials act as anti-inflammatories by interfering with the
pH balance inside cells. It is also known that
antimalarials protect against the damaging effects of
ultraviolet light. These medications have the potential to
put the disease into remission. Antimalarials may take
several months before the full benefit is shown. It is important to get an eye
exam every 6 months while taking these drugs as they can effect the
vision. Other possible side effects include dizziness,
skin rash,
hair loss, nausea, vomiting, and diarrhea.
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Corticosteroids (steroids) - The most
common corticosteroid used in
treating Lupus is Prednisone.
Corticosteroids are hormones, produced in small quantities by
our adrenal glands, that have anti-inflammatory and
immunoregulatory properties. Synthetically produced
corticosteroids like Prednisone are used in Lupus to reduce
inflammation and suppress the immune system. Steroids do
have a lot of side effects, some that are very serious.
For this reason these drugs must be used in the smallest
effective doses possible for the shortest possible time.
Steroids can cause a rise in blood pressure and heart rate,
"thinning" of the bones (osteoporosis), increased
susceptibility
to infection, weight gain, round or "moon" face,
striae (stretch marks), acne, easy bruising, onset
of Diabetes, cataracts, and stomach ulcers.
Corticosteroids are also available in topical, injectable and
inhaleable applications. These applications are used to
treat specific symptoms such as certain rashes. They have
far fewer side effects than systemic steroids.
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Immunosuppressives/Cytotoxic
Drugs (Chemotherapy) - Drugs that suppress
the body's immune response are a common
treatment for life threatening Lupus.
These drugs are also known as cytotoxic drugs or chemotherapy.
Cytoxic means "toxic to cells". Cytotoxic drugs are just
that, they destroy cells. The medications listed below
specifically destroy immune system cells. Because they
don't only destroy the "bad" cells, these medications can come with serious side effects.
These medications are not for mild Lupus but can be very useful
in life threatening SLE. They are also steroid sparring
medications. Blood counts should be monitored while on
these medications as low blood counts are a common and dangerous
side effect. These medications may reduce your body's
ability to fight
infections so contact your doctor if you experience fever,
chills, swollen glands, etc.
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Mycophenolate Mofetil (CellCept) -
Mycophenolate Mofetil is an immunosuppressive drug that has been
used in transplant patients for many years. It is now
becoming more and more popular in the treatment of Lupus
Nephritis. Side effects of Mycophenolate Mofetil include headache, nausea, vomiting, diarrhea, heartburn,
weakness, and increased risk of developing
opportunistic
infections. Do not take antacids within 2 hours before
or 4 hours after taking Mycophenolate Mofetil. Do not eat
2 hours prior or 1 hour after taking Mycophenolate Mofetil.
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Azathioprine (Imuran, Azasan) -
Azathioprine is another medication used to prevent organ
rejection. It is also approved to treat Rheumatoid
Arthritis. Side effects of Azathioprine most often
are upset stomach, vomiting, diarrhea, muscle aches and rarely
include mouth sores, cough, lack of energy, loss of appetite
stomach pain, yellowing of the eyes, flu-like symptoms, rash, or
blurred vision. If you experience any of the rare side
effects let your doctor know immediately.
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Methotrexate (Rheumatrex, Trexall) - This
medication is a cancer treatment that is sometimes used in
Lupus. It is usually taken orally, once a week, but
sometimes it is give by injection. While on this
medication, drink plenty of fluids to keep it moving through
your system quickly. Folic Acid supplementation is often
recommended while using methotrexate. This medication may make you more
sensitive to the sun. Common side effects include nausea,
vomiting, increased risk of
opportunistic
infections and loss of appetite. Check with your
doctor immediately if you experience blood in urine or stool,
bloody vomit, diarrhea, reddening of skin, joint pain, stomach
pain, and swelling of the feet or lower legs.
Pregnancy must be avoided during treatment and for one cycle
after treatment. During and immediately after treatment,
fertility may be impaired. Risk of long term infertility
is very low even after treatment with high doses.
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Cyclophosphamide
(Cytoxan, Neosar) - Cyclophosphamide is a drug that is
mostly used to treat many different types of cancer, but is also
used in Lupus. It has become the "gold standard" of
treatment for severe, active, major
organ involvement. Cyclophosphamide can be given orally
but typically is given intravenously because the IV version is
associated with fewer bladder problems and malignancies than the
oral version. It is very important to drink plenty of
fluids and to urinate frequently while on Cyclophosphamide
to dilute the concentration of the drug in your bladder.
Cyclophosphamide may cause nausea, increased risk of developing
some cancers, temporary or permanent sterility, bleeding from
the bladder (risk greatly reduced by drinking fluids), hair
loss, increased risk for
opportunistic
infections.
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Plasmapheresis - This procedure uses a
machine called a cell separator to separate the fluid part of
the blood, called plasma, from the blood cells. The blood
cells are returned to the patient and the plasma, which carries
the antibodies, is discarded. Risks include a drop in blood
pressure, a reduced resistance to infections and allergic
reactions to the replacement fluids. The procedure does
not prevent the antibodies from being reproduced so they will
rebuild. Immunosuppressive drugs may be used to slow the
rebuilding.
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Stem Cell Transplants - Stem Cells are
the undifferentiated, or immature blood cells, that turn into
mature cells in the bone marrow. Stem cell transplants has been
used to
treat
some cancers for decades, but using this procedure in the treatment of Lupus is brand new and
highly experimental. The concept of this procedure is to "re-teach" the
immune system to recognize it's own tissues. "This therapy
is analogous to rebooting a computer -- you wipe out the old
information, then allow it to re-learn. The immune system that
returns should function normally,". -Richard Jones, M.D.
Patients must have life threatening disease that has not
responded to other therapies in order even be considered for
this radical
treatment.
more about Stem Cells...
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Psychiatric
Drugs - Psychiatric drugs, particularly anti-depressants and
anti-anxiety medications are often used in Lupus patients.
Depression and anxiety are VERY common in Lupus both as a
symptom of the disease itself and as a side effect of dealing
with chronic illness. Anti-depressants, especially
amitriptyline, and trazadone are also used to
treat Fibromyalgia.
Fast working anti-anxiety medications such as Ativan can also be
very useful in breaking the anxiety, depression, pain,
sleeplessness cycle (more on that).
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Narcotic
Pain Relievers - Opioids such as hydrocodone (Vicodin,
Loratab), oxycodone (Percocet, OxyContin), and
hydromorphone (Dilaudid) are sometimes used to treat chronic
pain in Lupus when NSAIDS are not sufficient. It is
important to note that addiction, while a concern is actually
rare among people with chronic pain, especially those without
prior history of substance abuse. Pain relief is a right.
There is no reason to "tough it out". Untreated pain leads
to stress and only makes Lupus worse.
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Gabapentin
(Neurontin) - Used in Lupus to treat neuropathy and other
nerve pain. Also used to treat Postherpetic Neuralgia
after Shingles which is common with immunosupression.
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Antihypertensives
- Antihypertensives are used to lower blood pressure. High
blood pressure (hypertension) is common in Lupus especially with
steroid use. One class of antihypertensives called
angiotensin II receptor antagonists, drugs like Avapro and
Cozaar are especially common in Lupus nephritis due to their
ability to not only lower blood pressure but they may also slow
the progression of kidney damage. Beta blockers such as
Atenalol, are used to lower blood pressure as well as treat
several other symptoms such as high heart rate, migraine
prophylaxis, and tremor.
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Diuretics
- Commonly known as "water pills", diuretics are medications
that raise the body's urinary excretion rate. They are
commonly used in Lupus nephritis to treat edema, and to lower
blood pressure. The most commonly used diuretics are
furosemide (Lasix), hydrochlorothiazide, spironolactone, and
mannitol.
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Statin
Drugs - This category of drugs includes Lipitor, Zocor,
Crestor, Vytorin, etc. They are cholesterol lowering
medications. High cholesterol is common in Lupus
especially with steroid use. Regular liver function test
should be preformed while taking these medications. You
should report muscle pain while on these medications to your
doctor right away.
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Antacids
- Antacids are a very necessary part of Lupus treatment
especially when steroids or NSAIDs are in use. Proton Pump
Inhibitors such as Nexium, Prilosec, Prevacid, and Protonix are
daily preventative treatments for stomach acid.
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Herbal Treatments,
Vitamins and Supplements - Many herbal
treatments
and supplements claim to
treat
Lupus. Make sure you are always under the
supervision of a physician when taking these products!
Using these treatments can cause allergic reactions, overdoses,
or they may interact
with your other medications. Vitamins and minerals are an
important part of your Lupus treatment.
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Complementary
Therapies for Lupus - Therapies such as massage,
acupuncture, hypnotherapy, yoga and meditation can reduce
Lupus symptoms
and may even reduce flares.
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Retinoids
- Drugs such as isotretinoin (Accutane), etretinate (Tegison),
and acitretin (Soriatane) are some times used in resistant cases
of DLE and
SCLE.
Information on this page and this
entire website should never be substituted for medical advice.
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