Lupus

Treatment

The treatments for lupus can be as varied and individual as the disease itself and may change over time. But common-sense measures, such as rest, protection from sunlight, exercise, not smoking and a healthy diet are important for everyone with lupus.

Beyond this, medications can ease symptoms and reduce complications of lupus, but these drugs carry their own risks. In recent years, more judicious use of drugs has helped reduce some of these risks. The type of medication and length of treatment depend on which parts of the body are affected and the severity of symptoms. Yet because the course of lupus is so unpredictable, doctors may need to try several different drugs or change doses before finding an effective treatment.

Some medications used to treat lupus include:

• Nonsteroidal anti-inflammatory drugs. Aspirin or other nonsteroidal anti-inflammatory medications (NSAIDs) such as naproxen sodium and ibuprofen may reduce joint pain and inflammation. Check with your doctor before taking NSAIDs because some have been associated with serious side effects in people with lupus. What's more, a medication you've taken may have caused drug-induced lupus in the first place and taking more drugs may make the problem even worse.
• Antimalarial drugs. Although there's no known relationship between lupus and malaria, these medications may be useful for treating skin and joint problems and the ulcers that some people develop in the mouth or nose. Antimalarials may also prevent flares of the disease. Hydroxychloroquine (Plaquenil), the most commonly prescribed antimalarial, is sometimes used to control lupus in pregnant women because it appears to have fewer risks to the fetus than other medications used to treat lupus do.
• Corticosteroids. These drugs counter the inflammation of lupus, but can have serious long-term side effects, including weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection, already a major concern for people with lupus. The risk of side effects increases with higher doses and longer-term therapy. To help reduce these risks, your doctor will try to find the lowest dose that controls your symptoms and prescribe corticosteroids for the shortest possible time. Taking the drug every other day can also help reduce side effects. Corticosteroids are sometimes combined with another medication to help reduce the dose, and therefore the toxicity, of both drugs. Taking calcium and vitamin D supplements while using corticosteroids can reduce the risk of osteoporosis.
• Immunosuppressive medications. Drugs such as azathioprine (Imuran) and cyclophosphamide (Cytoxan) work by suppressing the immune system. Other medications that may be used to treat lupus include methotrexate (Rheumatrex), chlorambucil (Leukeran), cyclosporine (Neoral, Sandimmune) and mycophenolate mofetil (CellCept). Because immunosuppressive medications can have serious side effects, they're usually reserved for people with severe systemic disease or organ failure. Immunosuppressive drugs can cause anemia and a low white blood cell count, and increase your risk of infection and cancer.

Sometimes, even with the use of corticosteroids and immunosuppressive drugs, your kidneys may fail. In that case, you may need kidney dialysis or, if kidney failure is permanent, a kidney transplant.

New treatments
Researchers continue to look for more effective lupus treatments. Some studies have focused on blocking the expression of genes that may cause some of the symptoms of lupus, but any drugs that might result from this research are still years away.

Scientists are also investigating the use of existing drugs to treat lupus. One medication that has received attention is the cancer drug rituximab (Rituxan), which works by lowering the number of white blood cells in the body. Although people with lupus usually have lower than normal B cell counts, the B cells that do exist are involved in the autoimmune process. Studies of people with lupus who were treated with rituximab have shown promise, though more study is needed.

In late 2006 the Food and Drug Administration issued a warning to doctors advising them to use caution in prescribing rituximab to people with systemic lupus erythematosus (SLE). Two people with SLE who took rituximab died after contracting a serious brain infection. Though rituximab isn't approved for use in people with lupus, doctors can prescribe the drug for this use if they feel it may help. If you're considering taking rituximab, discuss all the potential risks with your doctor.

Self-care

Staying healthy requires extra effort for people with lupus, yet recognizing when symptoms are getting worse and knowing how to treat them can reduce your chance of permanent tissue or organ damage. Early treatment can also reduce the time you spend taking higher doses of medications, which can cause serious side effects.

In addition to learning to recognize the warning signs of a flare, such as pain, rash, fever, increased fatigue, abdominal discomfort, headache and dizziness, you also can take steps to help prevent flares in the first place:

• Get adequate rest. People with lupus often experience persistent fatigue that's different from normal tiredness and that isn't necessarily relieved by rest. For that reason, it can be hard to judge when you need to slow down. Many experts recommend eight to 10 hours of sleep a night and naps or breaks during the day as needed. Friends and family members need to understand and respect your need for rest.
• Be sun smart. Because ultraviolet light can trigger a flare, wear protective clothing such as a hat, long-sleeved shirts and long pants, and use sunscreens with a sun protection factor (SPF) of at least 15 every time you go outside, even if it's just a quick trip to the mailbox. Be sure that your ears, scalp and the backs of your hands are protected. Avoid tanning beds and stay out of the sun entirely when it's strongest, from 10 a.m. to 4 p.m. Because fluorescent and halogen lights also can emit UV rays and thus aggravate lupus, you may need to wear sunscreen and protective clothing indoors or use plastic devices that block UV emissions from indoor lights.
• Learn to deal with stress. Many people with lupus find that stress can bring on symptoms of their disease. It's not possible to avoid stress, especially when living with a chronic illness, but you often can learn to cope with it constructively so that it doesn't take such a severe physical toll. Try various relaxation techniques such as yoga, meditation or deep breathing or consider working with a counselor who can help you learn to deal with stress.
• Get regular exercise. It might seem counterintuitive to suggest exercise for people who are frequently exhausted, but in fact, physical activity in general and regular exercise in particular is extremely important for people with lupus. Exercise can help you recover from a flare, reduce your risk of heart attack, help fight depression and promote general wellbeing. Time outdoor activities so that you avoid the sun when it's most intense, and if you're having a flare, stay out of the sun entirely.
• Don't smoke. Smoking increases your risk of cardiovascular disease and can worsen the effects of lupus on your heart and blood vessels.
• Limit alcohol. Alcohol can affect your liver, kidneys, heart and muscles, and may interact with your medications.
• Eat a healthy, balanced diet. A well-balanced, nutritious diet is important for everyone, including people with lupus. Sometimes you may have dietary restrictions, especially if you have high blood pressure, kidney damage or gastrointestinal problems. And although no specific foods have been shown to cause or exacerbate lupus, it's best to avoid any food that seems to make your symptoms worse.
• Take care with vaccines. Immunizations using killed vaccines don't seem to make lupus worse, but you should avoid live vaccines such as the intranasal flu vaccine. It's best to check with your doctor regarding all immunizations.

If you're a woman with lupus and are considering becoming pregnant, seek medical counseling to determine what steps you can take to ensure the safest possible pregnancy. And keep in mind that some lupus medications are contraindicated during pregnancy.