Lupus Treatments

Systemic lupus erythematosus (SLE) is an incurable disease, but remedies are available for the relief of symptoms. As with any illness, early diagnosis is important. This is especially so with lupus as it can be particularly difficult to diagnose.

Reducing Inflammation

The majority of symptoms of lupus are due to inflammation, making anti-inflammatory medications the cornerstone of treatment. Because all medicines have side effects, doctors prescribe the mildest forms of medication to treat lupus symptoms. As medicines increase in strength and effectiveness, the side effects increase accordingly. Non-steroidal anti-inflammatory drugs or NSAIDs are the first course of action for joint and muscle pain associated with systemic lupus erythematosus.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Drug stores and supermarkets carry a wide variety of non-steroidal anti-inflammatory drugs. The most common, ibuprofen and naproxen, are marketed under the trade names Motrin®, Advil® and Aleve®. These drugs decrease inflammation by preventing the production of substances called prostaglandins, which are responsible for the body’s inflammatory responses. The muscle and joint pain in SLE is directly related to the inflammation and swelling that results from prostaglandin production. If over-the-counter dosages do not offer pain relief, doctors will prescribe higher does of these medications while monitoring the patient for possible side effects like stomach ulcers and blood thinning.

The FDA’s New Warning

Due to recent findings concerning COX-2 inhibitors, a specific group of NSAIDs, the FDA has asked manufacturers of NSAIDs to place warnings on medication packages describing the risk of cardiac and gastrointestinal events as a result of use.

Anti-Malarials and Lupus

If patients don’t get relief from NSAIDs, other medication options are available. Anti-malarials, drugs derived from the bark of the cinchona tree in Peru, were first used to treat infections like malaria. In the sixties, the active ingredients of these drugs, quinine and cinchona, were found to produce relief from joint pain in rheumatoid arthritis sufferers.

Anti-malarials soon found their place in reducing the symptoms of lupus. These drugs, hydroxychloroquine and chloroquine, help reduce joint pain and skin rashes in individuals who don’t respond to NSAIDs. Skin rashes were significantly improved in individuals who took anti-malarials for discoid lupus erythematosus. Anti-malarials also help to reduce inflammation of the pericardium (heart sac) and pleura (lung sac).

Anti-malarials can produce side effects like hair loss, dry skin, upset stomach and loss of appetite. Once the patient adjusts to the medication, however, many of the symptoms subside. If the symptoms persist, patients should contact their doctor. Occasionally, more severe side effects such as vision problems and seizures can occur.

Steroid Use for SLE Inflammation

Steroids may be prescribed for those with more severe symptoms related to SLE. Steroids have strong anti-inflammatory and immunosuppressive properties and are effective against SLE flare-ups. As with most medications, the strongest and most effective medications have side effects. Therefore, steroids are reserved for severe, life-threatening flare-ups related to SLE. Corticosteroids and prednisone are among the most effective drugs for the relief of inflammation. Steroids are prescribed at the lowest dose necessary for symptom relief and are gradually tapered off as the symptoms disappear. Steroids should be discontinued gradually to ease the adrenal glands back into normal functioning.

Steroid treatment is associated with potentially serious side effects including infection, osteoporosis, hypertension and diabetes. Because of this, steroids are given only as long as symptoms improve and blood tests show adequate levels of blood counts and kidney function.

Combining Steroids with Cytotoxins

In severe episodes of SLE that do not respond quickly to usual drug therapy, immediate steroid therapy combined with cytotoxic drugs can be initiated. Cytotoxic drugs like azathioprine and cyclophosphamide are powerful drugs that work over time. Cytotoxic drugs treatment allows steroids to be delivered at lower dose, thereby reducing the harmful side effects associated with higher doses of steroids.

Resources

Beers, M.H.