Lupus Treatment

What is Lupus?

Systemic Lupus Erythematosus – otherwise known as lupus – is an inflammatory autoimmune condition and typically affects women of reproductive age and causes joint pain. Other manifestations of the disease include fatigue, rash, dry eyes/mouth, inflammation in other parts of the body, and blood cell abnormalities.  One of the most worrisome complications of lupus is kidney disease, which is a common cause of dialysis dependence in young women. Lupus is also associated with an increased risk of heart attack and stroke.

Since this condition may have devastating complications and can affect quality of life, it is important to become educated about its symptoms, diagnosis, and treatment. By the end of this article, you will be able to answer the following important questions:

What causes Lupus?

The origin of lupus it not entirely clear, but researchers believe the disease is likely related to genetic (family history) and environmental factors. Lupus is an autoimmune disease – meaning that the body recognizes certain organs and tissues as being foreign and attacks itself.  This commonly manifests with inflammation in the joints, skin, mouth, eyes, and other organs.

How common is Lupus?

Lupus is a relatively common condition as it affects approximately 1.5 million Americans.  There are about 16,000 new cases of lupus diagnosed per year.

The disease is most frequently seen in woman of childbearing age (usually aged between 15-44 years), but can also affect men and children.

The disease is more commonly seen in non-Caucasian persons.

What are the symptoms and signs of Lupus?

Lupus can cause a wide variety of symptoms that affects multiple organ systems.  Some of the most common symptoms of lupus include:

  • Joint inflammation – warmth, redness, and swelling in the hands and knees
  • Photosensitive rash – especially over the face (butterfly rash)
  • Hair loss (alopecia)
  • Fatigue & depression
  • Dry eyes & mouth
  • Mouth or nasal ulcers
  • Eye inflammation
  • Raynaud phenomenon – cold-induced pain and color change in the fingers/toes
  • Serositis – inflammation of the lining of organs (eg, heart, abdominal cavity)
  • Blood cell abnormalities – anemia, low white blood cell count, low platelets

Joint inflammation often involves the hands, wrists, and knees – although any joint can become inflamed.  Tendons and bursa may also become inflamed, causing pain with joint movement.  The joint pain in lupus is usually worse in the morning and improves throughout the day.

Inflammation of the lining of the heart (pericarditis) or abdominal cavity (peritonitis) often results in chest pain and abdominal pain, respectively.  Patients with kidney involvement (lupus nephritis) may develop frothy urine, swelling in the legs, and high blood pressure.  Severe disease can lead to kidney failure.

Patient with lupus are also at increased risk for heart attack, stroke, and blood clots in the legs and lungs.

How is Lupus diagnosed?

Lupus is diagnosed based on the patient’s symptoms, physical examination findings, and laboratory tests.  Your doctor will usually check a comprehensive metabolic panel to evaluate your kidney and liver function.  In addition, they will also typically check a complete blood count, ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), and complement levels.

Urine analysis is commonly ordered to evaluate for protein and other urine abnormalities.  Women of childbearing age are also tested with a urine pregnancy screen.

Certain antibodies in the blood are highly suggestive of lupus.  These typically include:

  • ANA (anti-nuclear antibody)
  • Anti-double stranded DNA
  • Anti-Smith antibody

X-rays may be obtained from joints that are painful and swollen.

How is Lupus treated?

The treatment of lupus depends on the severity of disease and whether specific organs are involved.

Mild cases of joint inflammation with minimal involvement of other organs can usually be treated with non-steroidal anti-inflammatory drugs, including:

  • Advil (ibuprofen)
  • Naprosyn (naproxen)
  • Celebrex (celecoxib)
  • Mobic (meloxicam)

When joint inflammation is moderate to severe and other findings of lupus are present – such as rash, fatigue, and organ inflammation – your doctor may prescribe oral corticosteroids such as prednisone.  Corticosteroids work by reducing inflammation in the joints and organs, thereby decreasing pain and tissue swelling. 

Corticosteroids are generally not used long term due to their potential side effects such as weight gain, diabetes, immune suppression, and osteoporosis.  They should also be used cautiously in patients with a history of stomach ulcers and gastrointestinal bleeding.  In these cases, your doctor may recommend the simultaneous use of proton-pump inhibitors (e.g. Prilosec (omeprazole), Protonix (pantoprazole)) to reduce stomach acid.

Many patients with lupus are treated long term with a medication called Plaquenil (hydroxychloroquine) due to its more tolerable side effects and the fact that it may reduce lupus flares.  They may also be started on Trexall (methotrexate).  Rheumatologists typically prescribe these medications.

Patients with severe kidney disease may require Cytoxan (cyclophosphamide) or Cellcept (mycophenolate mofetil).  Patients with end-stage kidney disease requiring dialysis may be candidates for a kidney transplant.

 

Lupus Patient Summary:

  • Lupus is a relatively common disease that usually affects women of childbearing age.
  • It is a type of autoimmune disorder in which the body attacks itself inappropriately.
  • Patients with lupus often develop joint inflammation/pain, rash, inflammation of various organs, dry eyes/mouth, mouth ulcers, Raynaud phenomenon, blood cell abnormalities, and kidney failure – they are also at increased risk of heart attack and stroke.
  • The disease is diagnosed by symptoms, physical examination, and laboratory tests such as ANA, anti-double-stranded DNA, and anti-Smith antibodies – your doctor may also order x-rays of affected joints.
  • The treatment of lupus depends on disease severity – mild cases of joint pain without significant organ inflammation may respond to non-steroidal anti-inflammatory drugs (eg. Advil, Aleve, Naprosyn).
  • Moderate to severe cases accompanied by organ involvement often require the short-term use of corticosteroids (eg. Prednisone).
  • The long-term treatment of lupus usually involves the involvement of a rheumatologist and treatment with Plaquenil (hydroxychloroquine) – some patients may also receive Trexall (methotrexate).
  • Severe cases complicated by kidney disease may require Cytoxan (cyclophosphamide) or Cellcept (mycophenolate mofetil).
  • End-stage kidney disease often requires dialysis – some patients may qualify for kidney transplant.

References:

  1. Tsokos GC. Systemic lupus erythematosus. N Engl J Med. 2011 Dec 1;365(22):2110-21.
  2. Lam NC, Ghetu MV, Bieniek ML. Systemic Lupus Erythematosus: Primary Care Approach to Diagnosis and Management. Am Fam Physician. 2016 Aug 15;94(4):284-294.

 

Popular Lupus Medications

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.