Updated: November 4, 2019
Systemic lupus erythematosus (SLE) is an autoimmune disease where the immune system of body mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.
The immune system normally fights against dangerous infections and bacteria to keep the body healthy. When the immune system attacks the healthy tissue of body getting confused it for something foreign, an autoimmune disease occurs. The immune system fights infections by producing antibodies that bind to the microbes. People with lupus produce abnormal antibodies in their blood which are known as autoantibodies that target tissues within their own body rather than foreign infectious agents.
There is no permanent cure for SLE. People with SLE get affected differently. The goal of treatment is to relieve symptoms and prevent damage of organs by decreasing inflammation and the level of autoimmune activity in the body.
The treatment type will be decided on the symptoms and severity of an individual and and which parts of your body is affected by SLE. Treatments are most effective when you start them soon after symptoms develop. Many people with mild symptoms may not need any treatment. Sometimes only intermittent courses of anti-inflammatory medications is enough in this case.
High doses of corticosteroids in combination with other medications that suppress the body's immune system is required for those with more serious illness involving damage to internal organs.
As poor sleep quality was a significant factor in developing fatigue in people with SLE, rest during periods of active disease is more important. The physicians has to address sleep quality and the effect of underlying depression, lack of exercise, and self-care coping strategies on overall health. Resting sore joints decreases stress on the joints, and relieves pain and swelling. Carefully prescribed exercise is still important to maintain muscle tone and range of motion in the joints during these periods. Exercise not only strengthens the muscular support around the joints but also prevents the joints from freezing up and improves and maintains joint mobility. It also helps with weight reduction and promotes endurance. You can simply decrease the intensity and/or frequency of the activities that consistently cause joint pain.
Sunscreens, sun avoidance, and sun protection clothing are used to protect from sun sensitivity. Topical cortisone medications are used for certain types of lupus rash.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, and sulindac are helpful in reducing inflammation and pain in muscles, joints, and other tissues. Since the response to NSAIDs varies from person to person, usually doctors try different NSAIDs to find the most effective one with the fewest side effects. Stomach upset, abdominal pain, ulcers, and even ulcer bleeding are the most common side effects of NSAIDs. These are usually taken with food to reduce side effects.
Sometimes misoprostol are given simultaneously with NSAIDs to prevent ulcers.
As compared to NSAIDs, corticosteroids are more effective in reducing inflammation and restoring function when the disease is active. These are particularly used when internal organs are affected for getting instant relief. Corticosteroids can be given by mouth, administered intravenously or injected directly into the joints and other tissues.
When given in high doses over prolonged periods, these medications can generate serious side effects. For this reason the doctor will try to monitor the activity of the disease in order to use the lowest doses that are safe. Side effects of corticosteroids include weight gain, diabetes, facial puffiness, thinning of the bones and skin, infection, cataracts, and death of the tissues in large joints.
Plaquenil is an antimalarial medication which is also effective for fatigue, skin problems, and joint disease for people with SLE. Flare-ups of lupus can be prevented by taking Plaquenil consistently. Side effects of this medication are very rare but can include diarrhea, upset stomach, and eye-pigment changes.
Eye-pigment changes are rare but require monitoring by an ophthalmologist if you are getting treatment with Plaquenil. Plaquenil can decreases the frequency of abnormal blood clots in people with systemic lupus. It can be used to to prevent the blood clots for those SLE people who are at some risk for blood clots in veins and arteries. Example include people with phospholipid antibodies (cardiolipin antibodies, lupus anticoagulant, and false-positive venereal disease research laboratory test). Plaquenil not only reduces the chance for re-flares of SLE, but also can be beneficial in thinning the blood to prevent abnormal excessive blood clotting. Plaquenil is commonly used in combination with other treatments for lupus. Plaquenil and Corticosteroids, such as prednisone,are safely used to treat lupus during pregnancy. Sometimes, intravenous gamma globulin can be used for pregent women with histories of premature miscarriage and those with low blood-clotting elements (platelets). As the the effect seemed independent of immune suppression, it can be used for long-term.
Other antimalarial drugs, such as chloroquine or quinacrine, are considered and can be used in combination with Plaquenil for resistant skin disease. Dapsone and retinoic acid (Retin-A) are some of the alternative medications used for skin disease. Retin-A is often effective for an uncommon wart-like form of lupus skin disease. Immunosuppressive medications can be considered for more severe skin disease.
These medications are also called cytotoxic drugs that suppress immunity of the body. They are sometimes referred to as chemotherapy because they are also used to treat cancer. Generally the dose used in cancer treatment is much higher than those used to treat lupus. Immunosuppressive medications are used for treating people with SLE when the disease is severe. It is used to prevent damage to internal organs. Azathioprine, cyclophosphamide, chlorambucil, cyclosporine, and the disease-modifying drug methotrexate are some of the examples of immunosuppressive medications. All immunosuppressive medications can seriously decrease blood-cell counts and increase risks of infection and bleeding. Since there is a high risk associated with the fetus, these medications are not advisable to take during pregnancy or conception. Other side effects are specific for each medicine. For examples, methotrexate can cause liver toxicity, while cyclosporine can impair kidney function.
Mycophenolate mofetil (CellCept) can also be used as an effective medication for lupus, particularly when it is associated with kidney disease. It has been found helpful in reversing active lupus renal disease and in maintaining remission after it is taken for a peroid of time. Because of its lower side-effect, it is preferable over traditional immune-suppression medications.
Plasmapheresis is sometimes used to remove antibodies and other immune substances from the blood to suppress immunity in SLE patients with serious brain or kidney disease. Plasmapheresis is a process of removing blood and then returning the blood to the body with its antibodies removed after passing the blood through a filtering machine. Actually filtering of antibodies is done in this process.
People with SLE can develop seriously low platelet levels. This happens in rare case, but when the platelet levels are very low, the risk of excessive and spontaneous bleeding increases. Surgical removal of the spleen is sometimes performed to improve platelet levels as it plays a key role in platelet destruction. Plasmapheresis can also be used to remove certain harmful proteins called cryoglobulins that can lead to vasculitis. Dialysis and/or a kidney transplant is required for the people with SLE who have kidney damage in its end-stage.
Rituximab is an intravenously infused antibody used in treatment of lupus that suppresses a particular white blood cell, called as B cell, by decreasing their number in the circulation.
B cells have been found to play a central role in lupus activity. Therefore, when they are suppressed, the disease tends toward remission. This may particularly helpful for people with kidney disease.
Another new B-cell-suppressing treatment is belimumab. It works by blocking the stimulation of the B cells (a B-lymphocyte stimulator or BLyS-specific inhibitor). It is approved for the treatment of adults with active autoantibody-positive SLE who are receiving standard therapy. Patients with severe active lupus nephritis or severe active central nervous system lupus are not recommended for this treatment as the efficacy of belimumab has not been evaluated in these patient.
If you have SLE, it is also important to:
There is no specific lupus diet. However, low-dose diet supplementation with omega-3 fish oils could help patients with lupus by decreasing inflammation and disease activity. This will also help decreasing the risk of heart disease.
A balanced diet that includes plant-based foods and lean sources of protein is recommended for patient of SLE. Dehydroepiandrosterone or DHEA is a diet supplementation that has been shown to improve or stabilize signs and symptoms of SLE. DHEA is commonly available in health-food stores, pharmacies, and many groceries. This is helpful in reducing fatigue, improving thinking difficulties, and improving quality of life in people with SLE.
The outcome for people with SLE is improving each decade with the development of more accurate monitoring tests and treatments. The role of the immune system in causing this diseases is becoming more clear by research. Therefore more effective treatment methods are developed for the treatment. An example of new developed method is stem-cell transplantation. This involve immune eradication with or without replacement of cells that can re-establish the immune system.
People with SLE are at a increased risk for developing cancer, especially blood cancers, such as leukemia and lymphoma. But the risk is also there for breast cancer. The altered immune system that is characteristic of SLE is related to this risk factor.
Women with SLE are at increased risk for heart disease or coronary artery disease. Therefore, the risk factors for heart disease, such as elevated blood cholesterol, high blood pressure, smoking and obesity should be minimized. These risk factors should be monitored on a regular basis.
Oral contraceptives do not increase the rate of flares of systemic lupus erythematosus. However, women who are at increased risk of blood clotting, such as women with lupus who have phospholipid antibodies including cardiolipin antibody and lupus anticoagulant are advised to avoid any birth-control pills or estrogen medications.
Most people with SLE will require medicines for a long time. Mostly they require hydroxychloroquine indefinitely. The disease tends to be more active during the first years after diagnosis in people under age 40.
Women with SLE can get pregnant and deliver a healthy baby. However, the presence of SLE antibodies or antiphospholipid antibodies raises the risk of miscarriage. Women with SLE can prevent serious heart or kidney problems by proper treatment.
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