Treatment for Lupus
33. Is there a cure for lupus?
At the present time there is not a cure for lupus, but there certainly is effective treatment.
34. How is lupus treated?
The majority of symptoms of lupus are due to inflammation and so the treatment is aimed at reducing that inflammation. This can be done through a number of different medications. There are four families of medications used in the treatment of lupus. They include:
- Nonsteroidal Anti-inflammatory Drugs - drugs such as ibuprofen (Advil & Motrin), naproxen, (Naprosyn & Aleve), sulindac (Clinoril), piroxicam (Feldene), diclofenac (Voltaren) to name a few.
- Corticosteroids - drugs such as prednisone, prednisolone, medrol, deltasone, cortisone and others.
- Anti-malarials - these have been found to be effective in treating the joint pain, skin rashes and ulcers that some people develop on the inside of their nose or mouth. Plaquenil (hydroxychloroquine) is probably the most commonly prescribed anti-malarial drug in the United States. There is no known relationship between lupus and malaria.
- The fourth family of medications, immunosuppressants (or immunomodulating) /chemotherapy, is generally reserved for those individuals who have the most severe flares of lupus; or to enable the steroid dose to be reduced. A severe flare is one that affects an organ to the degree that the function is impaired. When this happens something has to be done to preserve the function of the organ and that's when immunosuppressive or chemotherapy medications are prescribed. These actually suppress the over activity of the immune system brought on by the lupus, and help limit the damage and preserve the function of the involved organ. (Lupus is NOT a form of cancer).
The majority of people who have lupus are treated with the first three families of medications, the nonsteroidals, corticosteroids and the anti-malarial drugs. These may be used either alone or in combination. Since individuals respond differently to medications, it may take time before you are able to determine, through trial & error, which medication at which dose provides relief of the symptoms of lupus. Frequently physicians will try one medication see how it works and if it doesn't work, they may have to change the dose or switch to another medication.
Medications Used in the Treatment of Lupus
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Steroids in the Treatment of Lupus
Anti-Malarials in the Treatment of Lupus
Immune Suppressants and Related Drugs Used for Lupus.
I don't want to go on prednisone. Are there any other treatments available?
In addition to corticosteroids, lupus can be treated with non-steroidal anti-inflammatory drugs, anti-malarial medications, and chemotherapy drugs. There can be situations where steroids are the best choice of therapy and the other medications are not indicated or are ineffective.
What can I do about the weight gain brought on by the prednisone?
Increased appetite is well recognized as a side effect of corticosteroid therapy. Often times, just being aware that this increase in appetite may occur with the steroid therapy, is the first step towards managing the potential weight gain. If you have to go on steroids or if you have to increase your dosage of steroids, you may want to consider planning out a healthy diet during the time you're taking steroids and making sure that you stick to it. During those times, however, when you're really hungry, here are some things you can do to combat the munchies:
- Drink a large glass of low sodium vegetable juice cocktail
- Eat a bowl of air popped or low fat microwave popcorn
- Eat a plate of raw vegetables dipped in fat-free sour cream
- If you can, go for a walk
- Drink a cup of decaffeinated flavored coffee with low fat milk
These are low fat substitutions, which can reduce your overall caloric intake and hopefully curb your weight gain. Taking steroids can also increase water weight gain. You can help to cut down the amount of fluid retention by reducing your sodium and/or salt intake. This can be accomplished by avoiding processed or convenience food whenever possible. If you are going to be eating convenience or processed foods, check the label and make sure that no item contains more than 200 mg of sodium per serving. Or if you are eating a whole frozen dinner, for example, try and stay between 500 and 700 mg of sodium. If you can avoid processed meats such as luncheon meats, sausages or bacon, you'll be reducing your sodium intake and that's good. If you have a choice among fresh, frozen or canned vegetables, stay away from the canned and choose fresh or frozen because they are lower in sodium.
Support groups and commercial weight loss programs can assist in weight control efforts.
Do you recommend any herbs or vitamins for the treatment of lupus?
We do not recommend any specific herbs or vitamins. There is a great deal of interest in herbal medicine and vitamin therapy. However, this is an area that really requires further scientific study. There are many anecdotal reports of people who took a certain vitamin or herb and felt that it helped improve their lupus. However, you have to be careful because some herbs have been shown to contain dangerous contaminants. With vitamin therapy, you have to be careful of not overdosing.
In general if you are concerned about having adequate quantities of vitamins in your diet, you can take a single multi-vitamin per day. Calcium supplements, to prevent osteoporosis (bone thinning), are a good idea. Patients who are prescribed methotrexate are often told to further supplement their diet with folic acid.
35. Where is the BEST place to go for diagnosis and treatment of lupus?
There is no one single recognized center of excellence for the treatment and diagnosis of lupus in the United States today. The Lupus Foundation of America has no mechanism by which it can rate either hospitals or physicians. The general recommendation is to find a physician that is affiliated with a medical school -a university hospital for example. These health care institutions may have faculty on staff who are involved in lupus research, and are generally the most up-to-date on the latest advances in diagnosis and treatment of lupus. These are generally regarded as very good places to go for the diagnosis and treatment of lupus. Certainly the health care institutions with established reputations fit this description.