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Lupus
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Treatment of Lupus
There is no cure for lupus. Treatment is based on symptoms. With a combination of medication, rest, exercise, proper nutrition, and stress management, most individuals with lupus can often achieve remission or reduce their symptom levels. Medications used in the treatment of lupus may include:
Never take vitamins or herbal supplements without talking to your doctor first. They might not mix well with medicines you use to treat lupus.
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Aspirin and Other Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- NSAIDs are used to reduce pain and swelling in joints and muscles. They can help with mild lupus - when pain isn't too bad and vital organs are not affected. Aspirin, ibuprofen, and naproxen are some over-the-counter NSAIDs. You need a prescription for stronger NSAIDs. NSAIDs can cause stomach upset, heartburn, drowsiness, headache, fluid retention, and other side effects. NSAIDs also can cause problems in your blood, liver, and kidneys if overused.
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Antimalarial Drugs
- Medicines used to prevent or treat malaria are used to treat joint pain, skin rashes, and mouth sores. Two common antimalarials are hydroxychloroquine (heye-DROK-see-KLOR-uh-kween) (Plaquenil ®) and chloroquine (KLOR-uh-kween) phosphate (Aralen ® phosphate). Side effects of antimalarials can include stomach upset, nausea, vomiting, diarrhea, headache, dizziness, blurred vision, trouble sleeping, and itching.
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Corticosteroids
- Corticosteroids (KOR-tih-koh-STAIR-oyds) are hormones found in our bodies. Manmade versions are used to reduce swelling, tenderness, and pain in many parts of the body. In high doses, they can calm the immune system. Often, these drugs are called "steroids." They are different than steroids used by some people who play sports or lift weights. Corticosteroids come as pills or liquids, creams to apply to the skin, and as a shot. Prednisone (PRED-nuh-sohn) is one drug commonly used to treat lupus. Lupus symptoms tend to respond very quickly to these powerful drugs. Once this has happened, your doctor will want to lower your dose slowly until you no longer need it. The longer a person uses corticosteroids, the harder it becomes to lower the dose. But stopping this medicine right away can harm your body. Make sure to use your medicine exactly as your doctor tells you to.
Corticosteriods can have many side effects, so your doctor will give you the lowest dose possible. Short-term side effects can include: a round or puffy face, acne, heartburn, increased appetite, weight gain, and mood swings. These side effects typically stop when the drug is stopped. Long-term side effects can include: easy bruising, thinning skin and hair, weakened or damaged bones, high blood pressure, damage to the arteries, high blood sugar, infections, muscle weakness, and cataracts. Your doctor can prescribe medicines to take with corticosteroids to prevent some side effects, such as osteoporosis.
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Immunosuppressive Drugs/Chemotherapy
- These agents are used in severe cases of lupus, when major organs are not working well and other treatments do not work. These drugs suppress the immune system to limit the damage to the organ. Examples are azathioprine (az-uh-THEYE-uh-preen) (Imuran®) and cyclophosphamide (seye-kluh-FOSS-fuh-myd) (Cytoxan®). These drugs can cause serious side effects including nausea, vomiting, hair loss, bladder problems, decreased fertility, and increased risk of cancer and infection.
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Other Therapies
- In some patients, methotrexate (Folex, Mexate, Rheumatrex), a disease-modifying antirheumatic drug, may be used to help control the disease. Other treatments may include hormonal therapies such as dehydroepiandrosterone (DHEA) and intravenous immunoglobulin (proteins derived from human blood), which may be useful for controlling lupus when other treatments haven't worked.
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. In addition to medications for lupus itself, in many cases it may be necessary to take additional medications to treat problems related to lupus such as high cholesterol, high blood pressure, or infection.
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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 doctor about the relative values of complementary and alternative therapies allows the patient to make an informed choice about treatment options.
You and your doctor should review your treatment plan often to be sure it is working. Tell your doctor about any side effects or if your medicines no longer help your symptoms. Tell your doctor if you have new symptoms. Never stop or change treatments without talking to your doctor first. Also, it is likely that you will need other drugs to treat conditions that are linked to your lupus, such as drugs to treat high blood pressure or osteoporosis.
Prognosis for Lupus
The prognosis for lupus varies widely depending on the organs involved and the intensity of the inflammatory reaction. The course of lupus is commonly chronic (lasting a long time) and relapsing, often with long periods of remission. Most individuals with lupus do not develop serious health problems and have a normal lifespan with periodic doctor visits and treatments with various drugs.
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References:
1) National Institute of Neurological Disorders and Stroke
February 2007
www.ninds.nih.gov
2) U.S. Department of Health and Human Services
March 2009
www.womenshealth.gov
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