Understanding Lupus: Know Symptoms, Treatment and More

What is Lupus?

Lupus is a chronic, often debilitating autoimmune disease that primarily affects women over the age of 15. Lupus can affect virtually any part of the body, and it typically begins during a patient's teenage years or early adulthood. The condition may present with mild or severe symptoms that range from mild fatigue to difficulty breathing, ulcers in the mouth and on the skin, mouth sores, hair loss and skin rashes.

Causes of Lupus

The exact cause of lupus is unknown. There are many factors that may contribute to the development of lupus, including genetics, environment, hormones and medications.

The most common form of lupus is systemic lupus erythematosus (SLE). The symptoms can develop over a period of months or years and include fever, joint pain, mouth sores and rashes on the cheeks. SLE causes extreme fatigue in most people who have it.

When people talk about lupus, it may refer either to systemic lupus or to one of the other three variants: discoid, drug-induced, or neonatal.:

• Systemic Lupus Erythematosus (SLE), the most common form of lupus

• A Cutaneous Lupus sufferer always has a form of lupus limited to the skin.

• Drug-induced Lupus is a disease similar to lupus which some drugs can cause. It takes the form of skin and joint inflammation, but other organs can also be affected.

• Neonatal Lupus: Early-onset neonatal lupus erythematosus (ENLE) is a rare condition that affects infants of women with lupus.

Treatment Options for Lupus

The most common treatment options for lupus are corticosteroids or chemotherapy drugs. These drugs will suppress the immune system which is why they are prescribed to people with lupus. They will also help reduce the symptoms and signs of their condition. Corticosteroids and chemotherapy drugs do not get rid of lupus, but they can make it easier to manage the symptoms

The patient must take anti-inflammatory medication on a daily basis, as well as other medications based on their results from blood tests. Patients may need medical treatments for weeks, months or even years in order to manage their symptoms effectively and live an active life

How to Manage Stress with a Chronic Illness like Lupus

Stress is a major contributor to the exacerbation of symptoms in chronic illnesses. It is important to know how to manage your stress levels, both medically and mentally.

You can start by not overdoing it on your physical activity. It may seem like the best way to de-stress, but it's actually quite the opposite, so you have to be careful of that. Try not to stay up too late at night (especially before bed), don't drink too much caffeine or alcohol, and try meditation.

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Is there a diet for people who have lupus?

A diet that may help someone with lupus is a Mediterranean diet, which is high in healthy fats like olive oil, omega-3s, and nuts. All this does is reduce inflammation caused by the disease. A ketogenic diet can also be helpful as it helps regulate blood sugar levels which can help with symptoms such as fatigue and mood swings. It's best to talk to your doctor before making any drastic changes in your diet.

Medications used to treat lupus

Anti-inflammatory drugs are among the simplest to-access and administer. Over-the-counter pain relievers also have many medicinal uses and can be used as a very secondary form of treatment.

Anti-inflammatory medications are the most common drugs used to relieve symptoms of lupus like fever, arthritis, or pleurisy. The stress on the immune system that causes these symptoms can be reduced by taking anti-inflammatories. These symptoms often improve (within several days) after beginning treatment. For many people with lupus, the anti-inflammatory drug may be the only medication they need to control their condition.

Aspirin

• A painkiller with anti-inflammatory properties and the function to control some symptoms of Lupus, this also has anticoagulant (meaning it can prevent blood from clotting) and can irritate your stomach.

Acetaminophen (Tylenol®)

• Tylenol can be used to relieve pain. It's safer on your stomach than aspirin and it doesn't control lupus, but it does help with inflammation. Most people have no side effects when taking Tylenol, but in some cases liver problems have occurred.

Non-Steroidal Anti-Inflammatories (NSAIDs): Ibuprofen (Motrin®), naproxen (Naprosyn®), indomethacin (Indocin®), nabumetone (Relafen®) and celecoxib(Celebrex ®)

• Reduces inflammation. They are especially good for managing joint pain and stiffness. Some NSAIDs work better than others and you may need to experiment with different drugs until you find the one that's right for your condition. NSAIDs can irritate the stomach lining but it doesn't happen in everyone so it's worth a try before abandoning them altogether.

• NSAIDs may also lead to serious gastrointestinal problems such as bleeding ulcers. To reduce the chance of this, it is best to take NSAIDs with food, milk or antacids. Antacids such as omeprazole (Prilosec®) and lanzoprazole (Prevacid§) can be taken alongside misoprostol (Cytotec®) for reflux symptoms. This may require a prescription from your GP.

• The side effects of NSAIDS, including abnormal urinalysis result, may be mistaken for signs of active Lupus. Recognizing this is important as the symptoms will go away when the drug is stopped.

• You should always be cautious about taking too many NSAIDs. Taking too much can reduce the blood flow to your kidneys and make it difficult for them to remove waste from your body. If you want to take an NSAID, there are both over-the-counter and prescription options, though certain types come with a higher risk of side effects.

Corticosteroids

Corticosteroids are man-made prescription drugs that mimic the effects of naturally occurring cortisol. The jobs of hormones is to act as a chemical messenger in the body.

Cortisol has many functions, including regulating blood pressure levels and the immune system. Corticosteroids prescribed for autoimmune conditions are not the same as anabolic steroids.

Steroid drugs can work quickly to reduce the swelling, warmth, tenderness and pain in the parts of the body that are affected. They do this by lessening the immune system’s response. Prednisone is the most commonly prescribed steroid for lupus.

Most people with lupus take steroids in pill form. However, creams or gels applied to the skin sometimes work better for cutaneous (skin) lupus. In some cases, liquid steroids may be injected straight into a joint or directly into a skin lesion.

You may be given a prescription for steroids to be taken every other day, which means that you are advised to take them one day and then wait a day before taking them again.

Steroids can produce a variety of side effects, including:

• Acne round or moon-shaped face, weight gain or hair growth.

• Fluid retention and a redistribution of fat leading to a swollen face and abdomen, but thin arms and legs.

• Fragile skin that bruises easily.

• The growth rate of children is below normal.

• Irritability, agitation, excitability, insomnia or depression can be caused by medical conditions.

• Someone who uses a lot of steroids will show changes in their appearance and mood more easily than someone who doesn't.

Long-term use of steroids can lead to additional side effects such as:

• Long-term steroid use can increase your risk of infection. Steroids are known to cause impaired healing, so if you have an open wound, be sure to clean and protect it carefully.

• Avascular necrosis occurs most often in the hip. The destruction of bone causes agony. Periodic pain relief can be achieved by having a total joint replacement.

• Osteoporosis makes your bones fragile, which is especially hazardous in the back. This often leads to compression fractures of the spine and severe back pain.

• Muscular weakness and cataracts are also potential side effects.

Antimalarials

Antimalarials are medications that are taken alongside anabolic steroids and other drugs. They are used in part for balancing the dose of the other drugs.

Antimalarials are often prescribed for skin rashes, mouth ulcers and joint pain. They also have a mild anti-inflammatory effect and prevent blood clots from forming in certain instances of lupus.

Antimalarials can help lupus sufferers by reducing the production of auto-antibodies. This defense helps against damaging effects from ultraviolet light and improves skin problems.

The two most common antimalarials prescribed to patients with lupus are hydroxychloroquine (Plaquenil ® ) and chloroquine (Aralen®). Unlike with steroids, it may take months for these drugs to improve your lupus symptoms.

Antimalarial side-effects are usually mild & rare. They can include a stomachache or discoloration of the skin. These usually remit after the body adjusts to the drug.

It is possible to experience retinal toxicity from prolonged usage of certain antimalarial drugs. This can cause vision problems. Using a low dose of antimalarials in the case of lupus can lower your risk of developing this complication. People who are taking an antimalarial should get an eye exam before or soon after starting the drug. They should also visit an eye doctor annually.

Plaquenil (hydroxychloroquine) dose is associated with retinal toxicity. Long term users of high doses need to get eye checkups to prevent this side effect.

If you're pregnant, don't stop taking your antimalarial medication without discussing it with your doctor. Although there's a small chance the medication will affect your unborn child, this side effect is unlikely to be harmful. New research suggests that for women, the possibility of a flare is higher than that of harming the unborn baby.

Immunosuppressives (Immune Modulators)

Immunosuppressive drugs are prescription drugs used to dampen a person's immune system. They are particularly advisable when one is not able to take oral corticosteroids anymore, or when those can't bring lupus symptoms under control. But, there are side effects from these drugs.

if you are being treated with immunosuppressives, your physician should carefully monitor you. Immunosuppressive drugs decrease your body’s ability to fight off infections and increase the odds of getting viral infections. It may seem like you're completely in the clear after a minor injury at first, but there's actually a possibility it could lead to something more serious. This is why you should always notify your doctor if you notice any signs of infection such as redness, swelling or pain anywhere on your body and even realize that certain drugs can worsen the likelihood of infection.

It is important that only physicians who are experienced with immunosuppressive drugs (medicines that weaken the immune system) prescribe them. As immunosuppressive drugs have many different side effects, it is vital to work with a doctor who understands these medications.

Voclosporin (Lupkynis™)

• Developed to treat lupus nephritis. One of only two drugs specifically approved for lupus nephritis (along with Benlysta). It works by preventing an autoimmune response to reduce inflammation and damage to the kidneys. The most common serious side effect is infection.

Cyclophosphamide (Cytoxan®)

• Originally developed for use as a chemotherapy drug and also for use in cases of immunosuppressant, treatments.

• Cytoxan was traditionally taken as a pill, but today it's better administered intravenously. It showed improvements in kidney and lung disease. In women Cytoxan could affect the menstrual cycle, cause bladder problems and hair loss, or lead to sterility.

Methotrexate (Rheumatrex™)

• Originally, the medication was created to be a chemotherapy drug (to treat cancer), but it has also been used as an immunosuppressant (to treat lupus).

• The drug rituximab is known as the gold standard for the treatment of rheumatoid arthritis, and has been shown to have beneficial effects in people with lupus. Side effects of Rituximab can include sun-sensitive skin and lung infections, and liver damage.

• The common side effects of these drugs are headaches, mouth sores and nausea. Avoid certain alcoholic drinks while taking methotrexate and if you have kidney disease take only the amount prescribed by your doctor.

Azathioprine (Imuran®)

• Ceftriaxone is a strong antibiotic that is commonly used in cases of transplant rejection. It prevents inflammation pathways, which may help to keep the disease lupus under control. A low dose of steroids can be taken and the severity of liver and kidney disease seems to diminish, but ceftriaxone can also cause severe problems such as pancreatitis.

Anticoagulants

Blood clots can be life-threatening symptoms of lupus. Anticoagulant medication (low dose aspirin and prescription heparin) thin the blood to prevent it from clotting too easily. Warfarin is also an option for anticoagulants. If you became on warfarin for lupus, you will have to be monitored by your physician at least once a month to make sure your blood doesn't become too thin. Warfarin may be a lifelong treatment in some cases; it all depends on the severity of the illness.

Very recent research shows that people’s genetic makeup may influence how they respond to warfarin. Specifically, people with variations in two genes may need lower warfarin doses due to differences in how the body breaks down (metabolizes) warfarin and regulates the ability of warfarin to prevent blood from clotting. For this reason, the dosage and administration of warfarin must be individualized for each person.

Monoclonal antibodies (mAbs)

A monoclonal antibody is a single type of protein made in the lab that can recognize & attach to only one kind of substance in the body.

Benlysta® is a human monoclonal antibody designed to disrupt activation of B lymphocytes by interfering with BLyS, a protein required for B cell activity. Benlysta is the first and only drug specifically developed to treat lupus. It is approved to help individuals with lupus and lupus nephritis. Studies show that Benlysta can reduce autoantibody levels & decrease disease activity in some cases.

Repository Corticotropin Injection (H.P. Acthar Gel)

Acthar® contains a natural hormone called ACTH. It stands for adrenocorticotropic hormone, and is highly purified. Acthar may work by helping your body produce more natural steroid hormones – like cortisone. These hormones, such as cortisol and epinephrine which act as the 'fight or flight' hormone, may help your immune system develop its responses to inflammation caused by illness.

Please call Superior Compounding Pharmacy in Plymouth Michigan to speak with one of our licensed pharmacists today at 734-404-6065. We can help answer any medication questions that you may have.

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