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5 July, 2009

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Lupus and medications

Systemic lupus erythematosus (SLE) is an autoimmune disease. These are diseases in which people develop antibodies against their own cells, resulting in tissue damage. The tissues in the body become inflamed and trigger a wide range of symptoms. Lupus most commonly appears in women of childbearing age, for reasons unknown. The disease can be mild or life threatening and its cause is still a mystery. There is a range of drugs used to treat lupus, which include those that reduce the intensity of lupus flares, lupus symptoms or the associated inflammation. The type of drugs used and the prescribed dosage depend on factors such as the severity of the illness and the type of symptoms. A person with lupus should never alter the doses of their medications without prior consultation with their doctor. They should never take drugs for other unrelated conditions unless they are prescribed by the same doctor. Other drugs may not be compatible with their lupus medication.

Main types of drugs
The main types of drugs used to control lupus include:

Steroids
Anti-malarials
Aspirin
Non-steroidal anti-inflammatory drugs (NSAIDs)
Immunosuppressants
Cytotoxic chemotherapies.

Steroids
Steroids (or corticosteroids) are synthetic hormones that mimic the action of cortisone, a naturally occurring hormone produced by the adrenal glands. These drugs are usually taken in tablet form but may be injected in the case of a particularly severe lupus flare. Dosage depends on the severity of symptoms and the person’s general state of health, including age and weight. The main function of steroids is to treat inflammation. The flow-on effects of reduced inflammation include reduction of pain and fever. Steroids also dampen the activity of the immune system, which helps to reduce the severity of symptoms. It is very important not to cut back on the dose without your doctor’s consent and supervision. Introducing steroids to the body means the adrenal glands reduce production of their own hormones. If the medication is then stopped suddenly, the adrenal glands may not be able to manufacture enough hormones for normal body functions. This dangerous condition is called ‘adrenal insufficiency’.

Side effects of steroids
Some of the side effects may include:

Hair growth abnormalities
Increased susceptibility to bruising
Increased susceptibility to infections
Fluid retention
Swollen face
Increased appetite
Weight gain
Thinning of the skin
Indigestion, including heartburn
Acne
Osteoporosis
Joint damage (osteonecrosis)
Cataracts
Stomach ulcers
High blood pressure
Diabetes mellitus
Mood changes and mood swings.

Anti-malarial drugs
Anti-malarial drugs were designed to treat malaria, the illness caused by the bite from an infected mosquito. These drugs are also helpful to control the arthritis-like symptoms of joint pain and the sunshine-related skin lesions often associated with lupus. Certain anti-malarial drugs, such as hydroxychloroquine, are used to help alleviate fatigue. However, doses have to be maintained for weeks or even months before an improvement in symptoms occurs. In some cases, anti-malarials allow the person to take a lower dose of steroids.

Side effects of anti-malarials
Some of the side effects may include:

Nausea
Vomiting
Diarrhoea
Skin rashes
Skin colour changes
Loss of hair pigment
Seizures
Eye problems.

Aspirin
Aspirin is an effective treatment for the inflammation, pain and fever associated with lupus. Some people can’t tolerate aspirin because of its effects on the stomach lining. In these cases, a buffered or coated form of aspirin can be tried. Aspirin should always be taken with food.

Side effects of aspirin
Some of the side effects may include:

Nausea
Vomiting
Stomach irritation and bleeding
Allergic reaction
Thinned blood
Greater tendency to bruise.

Non-steroidal anti-inflammatory drugs (NSAIDs)
Most people with lupus only need to take non-steroidal anti-inflammatory drugs (NSAIDs) to manage their symptoms. NSAIDs have a similar effect to aspirin. Some people can tolerate them better than aspirin. NSAIDs are used to reduce inflammation, pain and fever associated with lupus. To minimise side effects, NSAIDs should be taken with food, milk or antacids.

Side effects of NSAIDs
Some of the side effects may include:

Tinnitus (ringing in the ears)
Nausea
Vomiting
Abdominal pain
Reduced blood supply to the kidneys
Stomach irritation and bleeding.

Immunosuppressants
Lupus symptoms are triggered by the abnormal activity of the immune system, the specialised group of cells and chemicals that fight infection. Immunosuppressants reduce lupus symptoms by depressing the immune system. Unfortunately, this leads to an increased susceptibility to infection, because the drugs aren’t selective – those parts of the immune system that function normally are depressed along with the abnormal parts. Immunosuppressants are very powerful and can provoke a wide range of side effects.

Side effects of immunosuppressants
Some of the side effects may include:

Increased susceptibility to infections
Incompatibility with other drugs
Anaemia
Low white blood cell count
Bone marrow changes
Ovarian failure
Bleeding from the bladder
Slightly increased risk of cancer.

Cytotoxic chemotherapies
Cytotoxic chemotherapy is the medical option of last resort; it is used when the person’s lupus is severe and all other drugs have failed to control the symptoms. Cytotoxic drugs act on the bone marrow where blood cells are born. A person undergoing this kind of treatment needs to have regular blood tests to make sure they have sufficient blood cells.

Side effects of cytotoxic chemotherapy
Some of the side effects may include:

Low blood cell counts
Increased susceptibility to infections
Stomach upsets
Nausea
Vomiting
Hair loss
Sterility
Slightly increased risk of cancer.

Medications to avoid
Lupus medications can interact dangerously with other drugs. Never take drugs for other unrelated conditions unless they are prescribed by the same doctor who treats your lupus. This includes over-the-counter medications that don’t require a doctor’s prescription. Generally, medications to avoid include:

Penicillin
Penicillin derivatives
Certain epilepsy drugs
Any drugs that have prompted a prior allergic reaction.

Other treatment options
In addition to medication, other treatments generally recommended for people with lupus include:

Limited sun exposure
Sunscreen lotions
Regular exercise
Annual flu vaccinations
Regular medical check-ups
Healthy, balanced diet
Limited alcohol.

Where to get help

Your doctor
A specialist (often a dermatologist, rheumatologist, nephrologist or immunologist)
Lupus Australia Foundation Tel. (03) 9650 5348

Things to remember

Lupus (systemic lupus erythematosus or SLE) is an autoimmune disease.
The principle form of treatment for lupus is medication.
Drugs used include steroids, anti-malarials, aspirin, non-steroidal anti-inflammatory drugs, immunosuppressants and cytotoxic drugs.
The type of drugs used and the prescribed dosage depend on factors such as the severity of the illness and the type of symptoms.

You might also be interested in:
Lupus.
Lupus and infections.
Lupus and pregnancy.
Lupus in men.
Lupus issues - discoid lupus.

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