From Our "Ask the Experts" files ...
ASK THE EXPERTS: Are people with lupus more prone to infections even if they are not taking immunosuppressive drugs?
A. There is some evidence that people with lupus are more likely to get infections than are completely healthy people, even when they are not taking corticosteroids (prednisone and similar medications). The most common infections are in the respiratory tract (colds, sore throats, sinusitis, bronchitis, pneumonia), the urinary tract (bladder or kidney infections), and the skin (boils, cellulitis, infected cuts). As soon as a person with lupus is taking corticosteroids every day, particularly more than 10 mg a day, the risk for infection goes up considerably. If you can take your corticosteroid doses once in the morning every other day, instead of every day, there is not much, if any, increase in the risk for infections. Of course, every-other-day treatment does not control active lupus as well as every day. Other medications used for moderate to severe forms of lupus, like azathioprine (Imuran), mycophenolate mofetil (Cellcept) and cyclophosphamide (Cytoxan), increase infections even more that having the disease does. Herpes zoster outbreaks (shingles), with painful blisters along the course of a nerve, is particularly increased by the immunosuppressive medications. In general, the more severe the lupus is, the higher the risk for infection, partly because of being sick and partly because of the treatments. In contrast, the anti-malarials do not increase infections (hydroxychloroquine -- Plaquenil -- is the most commonly prescribed).
There are excellent strategies to reduce your risk for infection. You should have your vaccinations up to date, including Pneumovax to prevent pneumococcal pneumonia. You should take a flu shot every year. Most women can tell accurately that a bladder infection is present, and you should contact your doctor to give a prescription promptly when symptoms begin. If you are taking high doses of immunosuppressive drugs and/or prednisone, ask your doctor about taking medications to prevent pneumocystis pneumonia. If you have frequent urinary tract infections, there are antibiotics taken once at bedtime, and agents that change the acid in the urine, that are effective at reducing urinary tract infection rates. If you suffer from outbreaks of herpes virus lesions/ulcers in your mouth, on your lips, or in genital areas, discuss preventive anti-viral treatment with your doctor. If you have been exposed to tuberculosis, you should have a PPD skin test (tuberculin) and consider taking 6 months of anti-tuberculosis antibiotics if the test is strongly positive. Finally, if it is possible to avoid people with bad colds or other communicable infections, you should do so. Of course, you cannot protect yourself from participating in life -- so use your common sense.
-- Bevra H. Hahn, M.D.
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