Chat Transcript - Dr. Joan Merrill, December 6, 2006
Moderator:
Here is a question from Jocelyn of Manila in the Philippines. My daughter, 15 yrs. had been diagnosed with SLE last September 2005. She had a flare last 12/20/2005, had meningitis (slight only) and she suffered a stroke (right side paralysis). She was given pulse therapy and antibiotics for meningitis. She is doing well now and is back to school. Her maintenance is aspirin, 15 mg. prednisone and calcium. Her menstruation came back 2 months ago. However, she is complaining of severe joint pains (shoulder, knee, fingers) every morning for about a month now. Her doctor only gives Tylenol 650 g. for pain. The pain does not disappear until we give ibuprofen 2 or 3 times a day. My question is: How can we lessen the pain without the Ibuprofen 3x day. I'm afraid of the long term effect.
Dr. Merrill:
It sounds like she might have arthritis. Have you called the doctor to be sure the doctor is aware of this problem? Teenagers are not always good communicators in a doctor’s office. She needs to be examined for arthritis or severe arthralgias or muscle inflammation and treated for those if they are still active. Another possibility is that rarely some muscle problems can be caused by prednisone. The doctor really needs to be made aware of the problem.
Moderator:
Our next question was posed by O.K. from New York City: What can you tell us about treating Lupus when it is diagnosed in a cocaine dependent patient?
Dr. Merrill:
People who are addicted to cocaine and are diagnosed with lupus have two potentially life-threatening conditions. So while treating the immediate problems related to lupus, there needs to be careful attention to the following immediate issues: a.) keeping the blood pressure under control, b.) being sure the cocaine has not already damaged the heart, and c.) getting that person into a program to stop the drug and rehabilitate them. Otherwise it might not be possible to give them the best care.
Moderator:
Donna from Liverpool, NY writes: I have been out of remission for about 6 months. It seems every time I come out of remission, it takes me longer and longer to go back into remission. Is this common? Also, I am taking Cellcept (2500 mg) daily. Is there a cheaper version of this drug that I can take or a generic form?
Dr. Merrill:
There is no generic CellCept now but it will not be this way for too much longer….it will come off patent in the near future. Other agents such as azathioprine or leflunomide can be used instead of Cellcept for some but not all conditions and in some but not all patients. Azathioprine is much less expensive but the dosing can be limited by the side effects in many (but not all) patients. Many pharmaceutical companies have patient assistance programs, depending on your income and insurance coverage you may be able to apply for some help in getting the Cellcept as well.
Moderator:
Here is a question from sunny, warm Nassau in the Bahamas. Andrea asks: How effective is the drug CellCept in the treatment of lupus nephritis.
Dr. Merrill:
There have been a number of studies published now, and it looks like it is at least as effective as the standard treatment (Cytoxan) and has fewer side effects. But some individual patients might do better on Cytoxan, just as others might do better on Cellcept. Also, I am not happy with how well any of them do. I hope someday soon we will have treatments (or combination of treatments) which will put people into remission in a more reliable way than any of these ….and keep them there. That’s why we are happy to see so many new drugs being tested for lupus now.
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