Treatment of Systemic Lupus Erythematosus
المؤلف:
Mary Louise Turgeon
المصدر:
Immunology & Serology in Laboratory Medicine
الجزء والصفحة:
5th E, P418-419
2025-09-30
120
For most patients with lupus, effective treatment and prevention methods can minimize symptoms, reduce inflammation, and maintain normal body functions. For photosensitive patients, avoidance of (excessive) sun exposure and the regular application of sunscreens will usually prevent rashes. Regular exercise helps prevent muscle weakness and fatigue. Immunization protects against specific infections. Support groups and counseling can help alleviate the effects of stress. Lupus patients should avoid smoking, excessive consumption of alcohol, over use or underuse of prescribed medication, and postponing regular medical checkups.
Medications are often prescribed for patients with lupus, depending on the organ(s) involved and the severity of involvement. Common medications include the following:
• Nonsteroidal antiinflammatory drugs (NSAIDs). NSAIDs are prescribed for a variety of rheumatic diseases, including lupus. Examples include acetylsalicylic acid (aspirin), ibuprofen (Motrin), and naproxen (Naprosyn). These drugs are usually recommended for muscle and joint pain and arthritis. Newer NSAIDs contain a prostaglandin in the same capsule (Arthrotec). The other NSAIDs work in the same way as aspirin, but may be more potent.
• Acetaminophen. Acetaminophen (Tylenol) is a mild analgesic that can often be used for pain. It has the advantage of causing less stomach irritation than aspirin but is not nearly as effective at suppressing inflammation as aspirin.
• Steroids (e.g., prednisone) are used to reduce inflammation and suppress activity of the immune system. Side effects occur more frequently when steroids are taken over long periods at high doses. These side effects include weight gain, a round face, acne, easy bruising, thinning of the bones (osteoporosis), high blood pressure, cataracts, onset of diabetes, increased risk of infection, stomach ulcers, hyperactivity, and increased appetite.
• Antimalarials. Chloroquine (Aralen) or hydroxychloroquine (Plaquenil), typically used to treat malaria, may also be useful for some individuals with lupus. Antimalarials are most often prescribed for the skin and joint symptoms of lupus.
• Immunomodulating drugs. Azathioprine (Imuran) and cyclophosphamide (Cytoxan), cytotoxic drugs, act in a manner similar to that of corticosteroids in that they suppress inflammation and tend to suppress the immune system.
Other agents (e.g., methotrexate, cyclosporin) can be used to control the symptoms of lupus. Some of these are used in con junction with apheresis, a blood-filtering treatment. Apheresis has been tried by itself in an effort to remove specific antibodies from the blood, but the results have not been promising.
Studies have suggested that immunosuppressive therapy targeted against the calcineurin pathway of T helper (Th) cells, such as tacrolimus, may be effective in the treatment of primary membranous nephropathy.
Newer agents are directed toward specific cells of the immune system. These include agents that block the production of anti DNA or that suppress the manufacture of antibodies through other mechanisms. Examples are IV immunoglobulin injections, which are given on a regular basis to increase platelet numbers.
• Anticoagulants. Anticoagulants range from aspirin at a very low dose to heparin or coumadin. Generally, such therapy is lifelong in those with lupus and follows an episode of embolus or thrombosis.
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