What is Lupus?

Standard

This is from the Lupus Foundation of America’s web page. You can read more at www.lfa.org.

What is Lupus

Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years. In lupus, something goes wrong with your immune system, which is the part of the body that fights off viruses, bacteria, and germs (“foreign invaders,” like the flu). Normally our immune system produces proteins called antibodies that protect the body from these invaders. Autoimmune means your immune system cannot tell the difference between these foreign invaders and your body’s healthy tissues (“auto” means “self”) and creates autoantibodies that attack and destroy healthy tissue. These autoantibodies cause inflammation, pain, and damage in various parts of the body.

  • Lupus is also a disease of flares (the symptoms worsen and you feel ill) and remissions (the symptoms improve and you feel better). Lupus can range from mild to life-threatening and should always be treated by a doctor. With good medical care, most people with lupus can lead a full life.
  • Lupus is not contagious, not even through sexual contact. You cannot “catch” lupus from someone or “give” lupus to someone.
  • Lupus is not like or related to cancer. Cancer is a condition of malignant, abnormal tissues that grow rapidly and spread into surrounding tissues. Lupus is an autoimmune disease, as described above.
  • Lupus is not like or related to HIV (Human Immune Deficiency Virus) or AIDS (Acquired Immune Deficiency Syndrome). In HIV or AIDS the immune system is underactive; in lupus, the immune system is overactive.
  • Our research estimates that at least 1.5 million Americans have lupus. The actual number may be higher; however, there have been no large-scale studies to show the actual number of people in the U.S. living with lupus.
  • It is believed that 5 million people throughout the world have a form of lupus.
  • Lupus strikes mostly women of childbearing age (15-44). However, men, children, and teenagers develop lupus, too.
  • Women of color are 2-3 times more likely to develop lupus.
  • People of all races and ethnic groups can develop lupus.
  • More than 16,000 new cases of lupus are reported annually across the country.
Advertisements

Costochondritis

Standard

Since I found out today this is what I have, I thought I would look into it. I got this information fromt he webite wedmd. Learn more about it. Thanks!

Costochondritis

Costochondritis Overview

Costochondritis is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone or sternum. The condition causes localized chest pain that you can reproduce by pushing on the cartilage in the front of your ribcage. Costochondritis is a relatively harmless condition and usually goes away without treatment. The cause is usually unknown.

  • Costochondritis (with unknown cause) is a common cause of chest pain in children and adolescents. It accounts for 10-30% of all chest pain in children. Annually, doctors evaluate about 650,000 cases of chest pain in young people 10-21 years of age. The peak age for the condition is 12-14 years.
  • Costochondritis is also considered as a possible diagnosis for adults who have chest pain. Chest pain in adults is considered a potentially serious sign of a heart problem by most doctors until proven otherwise. Chest pain in adults usually leads to a battery of tests to rule out heart disease. If those tests are normal and your physical exam is consistent with costochondritis, your doctor will diagnose costochondritis as the cause of your chest pain. It is important, however, for adults with chest pain to be examined and tested for heart disease before being diagnosed with costochondritis. Often it is difficult to distinguish between the two without further testing. The condition affects females more than males (70% versus 30%). Costochondritis may also occur as the result of an infection or as a complication of surgery on your sternum.
  • Tietze syndrome is often referred to as costochondritis, but the two are distinct conditions. You can tell the difference by noting the following:
    • Tietze syndrome usually comes on abruptly, with chest pain radiating to your arms or shoulder and lasting several weeks. Tietze syndrome is accompanied by a localized swelling at the painful area (the junction of the ribs and breastbone).

Costochondritis Causes

Costochondritis is an inflammatory process but usually has no definite cause. Repeated minor trauma to the chest wall or viral respiratory infections can commonly cause chest pain due to costochondritis. Occasionally, costochondritis as a result of bacterial infections can occur in people who use IV drugs or who have had surgery to their upper chest. After surgery, the cartilage can become more prone to infection, because of reduced blood flow in the region that has been operated on.

Different types of infectious diseases can cause costochondritis.

  • Viral: Costochondritis commonly occurs with viral respiratory infections because of the inflammation of costochondral junctions from the viral infection itself, or from straining from coughing.
  • Bacterial: Costochondritis may occur after surgery and be caused by bacterial infections.
  • Fungal: Fungal infections are rare causes of costochondritis.

Costochondritis Symptoms

Chest pain associated with costochondritis is usually preceded by exercise, minor trauma, or an upper respiratory infection.

  • The pain usually will be sharp and located on your front chest wall. It may radiate to your back or abdomen and is more common on your left side.
  • The most common sites of pain are your fourth, fifth, and sixth ribs. This pain increases as you move your trunk or take deep breaths. Conversely, it decreases as your movement stops or with quiet breathing.
  • The reproducible tenderness you feel when you press on the rib joints (costochondral junctions) is a constant feature of costochondritis. Without this tenderness, a diagnosis of costochondritis is unlikely.
    • Tietze syndrome, on the other hand, exhibits swellings at the rib-cartilage junction. Costochondritis has no noticeable swelling. Neither condition involves pus or abscess formation.
    • Tietze syndrome usually affects the junctions at the second and third ribs. The swelling may last for several months. The syndrome can develop as a complication of surgery on your sternum months to years after the operation.
    • When costochondritis occurs as a result of infection after surgery, you will see redness, swelling, or pus discharge at the site of the surgery.

When to Seek Medical Care

Call the doctor for any of the following symptoms:

  • Trouble breathing
  • High fever
  • Signs of infection such as redness, pus, and increased swelling at the rib joints
  • Continuing or worsening pain despite medication

Go to a hospital’s emergency department if you have difficulty breathing or any of the following symptoms occur. These symptoms are generally not associated with costochondritis:

  • High fever not responding to fever-reducers such as acetaminophen (Tylenol) or ibuprofen (Advil)
  • Signs of infection at the tender spot such as pus, redness, increased pain, and swelling
  • Persistent chest pain of any type associated with nausea, sweating, left arm pain, or any generalized chest pain that is not well localized: These symptoms can be signs of a heart attack. If you are not sure what is causing your condition, always go to the emergency department.

Exams and Tests

Costochondritis does not lend itself to diagnosis by tests. Personal history and physical exam are the mainstays of diagnosis. Tests however are sometimes used to rule out other conditions that can have similar symptoms but are more dangerous, such as heart disease.

  • The doctor will seek to reproduce tenderness over the affected rib joints, usually over the fourth to sixth ribs in costochondritis, and over the second to third ribs in Tietze syndrome. In costochondritis with unknown causes, there is no significant swelling of costochondral joints.
  • There is swelling as well as tenderness of the rib-cartilage junctions in Tietze syndrome. Although some doctors use the terms costochondritis and Tietze syndrome interchangeably, Tietze syndrome has a sudden onset without any preceding respiratory illness or any history of minor trauma. In Tietze syndrome, there is frequently radiation of pain to arms and shoulders as well as pain and tenderness associated with swelling at the spot that hurts.
  • Blood work and a chest X-ray are usually not helpful in diagnosing costochondritis. However, after sternum surgery, or for people at risk for heart disease, doctors will be more likely to do tests if you have chest pain and possible costochondritis to be certain you do not have any infection or other serious medical problems.
    • They will look for signs of infection such as redness, swelling, pus, and drainage at the site of surgery.
    • A more sophisticated imaging study of the chest, a gallium scan, is used to check for infection. It will show increased uptake of the radioactive material gallium in an area of infection.
    • In cases of possible infection, the white blood cell count may be elevated.
    • Chest X-ray should be obtained if pneumonia is a suspected cause of chest pain.
    • ECG and other tests will be done if a heart problem is being considered.
  • Costochondritis is a less common cause of chest pain in adults but one that occurs fairly frequently in people who have had cardiac surgery. The diagnosis can only be reached after excluding more serious causes of chest pain that are related to the heart and lungs. The appropriate studies, such as ECG, chest x-rays, blood test for heart damage (cardiac enzymes and troponin levels), and other studies will be done as indicated. Any chest pain in adults is taken seriously and not ignored. If you are concerned, consult with your doctor.

Costochondritis Treatment

Self-Care at Home

  • Treatment involves conservative local care with careful use of nonsteroidal antiinflammatory medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve) as needed.
  • Local heat or ice may be helpful in relieving the symptoms.
  • Avoid unnecessary exercise or activities that make the symptoms worse. Avoid contact sports until there is improvement in symptoms, and then return to normal activities only as tolerated.

Medications

  • Costochondritis responds to nonsteroidal antiinflammatory medications such as ibuprofen (Advil or Motrin) and naproxen (Aleve).
  • You may be given a local anesthetic and steroid injection in the area that is tender if normal activities become very painful and the pain does not respond to medications.
  • Infectious (bacterial or fungal) costochondritis should be treated initially with IV antibiotics. Afterward, antibiotics by mouth or by IV should be continued for another two to three weeks to complete the therapy.

Surgery

Surgical removal of the sore cartilage may be required if there is no response to medical therapy. Your doctor will refer you to a surgeon for consultation should this option be considered necessary.

Next Steps

Follow-up

You should see a doctor during recovery, and then once a year. Infectious costochondritis requires long-term, close follow-up.

Prevention

Because inflammatory costochondritis has no definite cause, there is no good way to prevent it.

Outlook

Noninfectious costochondritis will go away on its own, with or without antiinflammatory treatment. Most people will recover fully.

Infectious costochondritis responds well to IV antibiotics and surgical repair, but recovery may take a long time.

Recent Lupus News 10.06.2010

Standard

Hey everyone! I am taking the easy way out tonight and posting an article I found on medicalnewstoday.com. Hope you enjoy the article and tomorrow I hope to post a new post. Thanks and enjoy!

Lupus Research Investigator Says Breakthrough Holds Potential For New Treatment To Quiet Lupus

   

 

   

 

   

Researchers at the Dana-Farber Cancer Institute in Boston have identified a new type of cell in mice that dampens the immune system and protects the animal’s own cells from immune system attack.

This “suppressor” cell reduces the production of harmful antibodies that can drive lupus and other autoimmune diseases in which the immune system mistakenly turns on otherwise healthy organs and tissues.

The discovery, published in a recent issue of Nature (H Kim, et al.; Vol 467 in Letters), resulted from Lupus Research Institute funding to Harvey Cantor, MD, and colleagues on a separate immune system topic.

Now the discovery will be used to explore therapies that might control the hyperactive immune system in lupus. “These CD8+ T suppressor cells represent a potential new lever for lowering the strength of the immune response in autoimmune diseases such as lupus,” Dr. Cantor said.

Staying Open to Discovery

Until now, scientists searching for cells involved in quieting the immune system response had focused their hunt on “regulatory CD4+ T cells” – also known as CD4+ Treg. Some of these cells have been shown to prevent harmful inflammatory diseases and infections.

In the Nature study, Harvey Cantor, MD, and his team reported that not just CD4+T cells but CD8+ T cells as well include a subset that helps dampen the immune response. Instead of reducing inflammation like their CD4 cousins, the CD8+ T regulatory cells ensure that the immune system doesn’t produce antibodies that attack normal cells.

Lead author Hye-Jung Kim and colleagues made the discovery as they were winding up unrelated LRI-funded work into the role in autoimmunity of a protein found inside immune cells called osteopontin.

“Our LRI funds allowed us to carry out the early experiments that led to the definition of the CD8 suppressor cells.” – Dr. Cantor.

“We were testing osteopontin’s activity against a population of cells known as follicular T helper cells,” explained Dr. Cantor. “We noted that the cells were responsive to osteopontin but also that they expressed what we knew to be the target of suppressor CD8+ T cells.”

As next steps, Dr. Cantor and his team will investigate whether defective CD8+ T suppressor cells actually could be a cause of lupus and might serve as a powerful drug target for quieting the immune system response in autoimmunity.

About Lupus

Systemic lupus erythematosis is a chronic complex and potentially fatal autoimmune disease that affects more than 1.5-million Americans, mostly young women in their child-bearing years. Lupus causes the immune system to become hyperactive, forming antibodies that attack and damage the body’s own tissues and vital organs including the heart, brain, kidneys and lungs. Lupus is a leading cause of cardiovascular disease, kidney disease and stroke among young women. As yet, there is no known cause or cure but the progress of recent discoveries is highly promising.

Source:
Liane Stegmaier
Lupus Research Institute

Treatments for Lupus

Standard

This information is from the Lupus Cleveland Website. It shows the types of things used to treat Lupus and all the different manifestations of the disease. It is well written and easy to read. If you would like to understand Lupus better, this is a good article to read. Enjoy!

TREATMENT

Currently, there is no cure for lupus; however, early diagnosis and proper medical treatment can significantly help to control the disease. Symptoms often vary from one individual to another and treatment is based on specific indications in each person. Still, a few general guidelines can be listed:

  1. Regular rest is important when the disease is active. When the disease is in remission, increased physical activity is encouraged to increase joint flexibility and muscle strength.
  2. For the individual who is photosensitive, the regular use of sunscreens will help prevent rashes and irritations. For those who develop rashes, treatment with cortisone creams is very helpful.
  3. Achy joints (arthralgia) and arthritis generally respond to aspirin or aspirin-like drugs (non-steroidal anti-inflammatory drugs).
  4. The anti-malarial drug hydroxcholorquin (Plaquenil) is often prescribed for more severe joint or skin involvement.
  5. Cortisone drugs (the most commonly prescribed is Prednisone) are often used for more severe organ involvement. Not everyone with SLE needs cortisone. Cortisone, particularly in higher doses, has possible hazardous side effects.
  6. If you have a fever (over 100 degrees F), call your doctor.
  7. Go to your doctor for regular checkups. Regular checkups usually include blood and urine tests.
  8. When in doubt, ask. Call a doctor.

Treatment plans should meet the individual patient’s needs and may change over time. To develop a treatment plan, the doctor tries to:

  • Prevent flares
  • Treat flares when they do occur
  • Minimize complications

The doctor and patient should reevaluate the plan regularly to ensure that it is as effective as possible.

Several types of drugs are used to treat lupus. For people with joint pain, fever, and swelling, drugs that decrease inflammation, referred to as nonsteroidal anti-inflammatory drugs, or NSAIDs, are often used.

While some NSAIDs are available over the counter, a doctor’s prescription is necessary for others.

Common side effects of NSAIDs include stomach upset, heartburn, diarrhea, and fluid retention.

Some lupus patients also develop liver and kidney inflammation while taking NSAIDs. It is especially important to stay in close contact with the doctor while taking NSAIDs.
Antimalarials are another type of drug commonly used to treat lupus. These drugs were originally used to treat malaria, but they are also useful in treating lupus.
Antimalarials may be used alone or in combination with other drugs to treat fatigue, joint pain, skin rashes, and inflammation of the lungs. Continuous treatment with anti-malarials may prevent flares from recurring.

Side effects of antimalarials may include stomach upset and, very rarely, damage to the retina of the eye.

The most common treatment for lupus is corticoid steroid hormones. Corticoid steroids are related to cortisol, a natural anti-inflammatory hormone. They hold back inflammation very quickly.

Corticoid steroids can be given orally, in creams applied to the skin, or by injection. Since they are potent drugs, the doctor will use the lowest dose with the greatest benefit.

Short-term side effects of corticoid steroids include swelling, increased appetite, weight gain, and emotional ups and downs. These side effects usually stop when the drug is stopped.

It can be dangerous to stop taking corticoid steroids suddenly, so it is very important that a doctor recommend changes for the corticoid steroid dose.
Sometimes doctors give very large amounts of corticoid steroid for a short time by vein. With this treatment, typical side effects are less likely and slow withdrawal is not necessary.

Long-term side effects of corticoid steroids can include stretch marks, excessive hair growth, weakened or damaged bones, high blood pressure, damage to the arteries, high blood sugar, infections, and cataracts.

Typically, the higher the dose of corticoid steroids, the more severe the side effects are. The longer corticoid steroids are taken, the greater the risk of side effects becomes.
People with lupus who use corticoid steroids should talk to their doctors about taking supplemental calcium and Vitamin D. These supplements reduce the risk of fragile bones called osteoporosis.
For patients whose kidneys or central nervous systems are affected by lupus, a type of drug called an immunosuppressive may be used. Immunosuppressive hold the immune system back by blocking the production of some immune cells.

Immunosuppressive may be given orally or by IV.

Side effects of immunosuppressive may include nausea, vomiting, hair loss, bladder problems, decreased fertility, and increased risk of cancer and infection. The longer the treatment with immunosuppressive, the higher the risk of side effects becomes.

Since some treatments may cause harmful side effects, it is important to tell the doctor about any side effects right away. It is also important NOT to stop or change treatment without asking the doctor first.

Lupus and Osteoporosis

Standard

 

I got this information from webmd. It is interesting to me because I have both lupus and osteoporosis (from steroids use). It is important to remember that each person is unique and if you have any questions or concerns, please direct them to your physician.

What Is Lupus?

Lupus is an autoimmune disease, a disorder in which the body attacks its own healthy cells and tissues. As a result, various parts of the body – such as the joints, skin, kidneys, heart, and lungs – can become inflamed and damaged. There are many different kinds of lupus. Systemic lupus erythematosus (SLE) is the form of the disease that is commonly referred to as lupus.

People with lupus can have a wide range of symptoms. Some of the most commonly reported symptoms are fatigue, painful or swollen joints, fever, skin rashes, and kidney problems. Typically, these symptoms come and go. When symptoms are present in a person with the disease, it is known as a flare. When symptoms are not present, the disease is said to be in remission.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) at the National Institutes of Health, 90 percent of those diagnosed with lupus are women. The disease is three times more common in black women than white women. Women of Hispanic, Asian, and Native American descent are also at increased risk. Lupus typically appears in people between the ages of 15 and 45. Unfortunately, there is no cure for the disease.

What Is Osteoporosis?

Osteoporosis is a condition in which the bones become less dense and more likely to fracture. Fractures from osteoporosis can result in significant pain and disability. Osteoporosis is a major health threat for an estimated 44 million Americans, 68 percent of whom are women.

Risk factors for developing osteoporosis include:

  • being thin or having a small frame
  • having a family history of the disease
  • for women, being postmenopausal, having an early menopause, or not having menstrual periods (amenorrhea)
  • using certain medications, such as glucocorticoids
  • not getting enough calcium
  • not getting enough physical activity
  • smoking
  • drinking too much alcohol.

Osteoporosis is a silent disease that can often be prevented. However, if undetected, it can progress for many years without symptoms until a fracture occurs.

The Lupus – Osteoporosis Link

Studies have found an increase in bone loss and fracture in individuals with SLE. In fact, women with lupus may be nearly five times more likely to experience a fracture from osteoporosis.

Individuals with lupus are at increased risk for osteoporosis for many reasons. To begin with, the glucocorticoid medications often prescribed to treat SLE can trigger significant bone loss. In addition, pain and fatigue caused by the disease can result in inactivity, further increasing osteoporosis risk. Studies also show that bone loss in lupus may occur as a direct result of the disease. Of concern is the fact that 90 percent of the individuals affected with lupus are women, a group already at increased osteoporosis risk.

Osteoporosis Management Strategies

Strategies for the prevention and treatment of osteoporosis in people with lupus are not significantly different from the strategies for those who do not have the disease.

Nutrition: A diet rich in calcium and vitamin D is important for healthy bones. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Also, supplements can help ensure that the calcium requirement is met each day.

Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. While many people are able to obtain enough vitamin D naturally, excessive sun exposure can trigger flares in some people with lupus. These individuals may require vitamin D supplements in order to ensure an adequate daily intake.

Exercise: Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best exercise for your bones is weight-bearing exercise that forces you to work against gravity. Some examples include walking, climbing stairs, weight lifting, and dancing.

Exercising can be challenging for people with lupus who are affected by joint pain and inflammation, muscle pain, and fatigue. However, regular exercises such as walking can help prevent bone loss and provide many other health benefits.

Healthy lifestyle: Smoking is bad for bones as well as the heart and lungs. Women who smoke tend to go through menopause earlier, triggering earlier bone loss. In addition, smokers may absorb less calcium from their diets. Alcohol can also negatively affect bone health. Those who drink heavily are more prone to bone loss and fracture, both because of poor nutrition and an increased risk of falling.

Bone density test: Specialized tests known as bone mineral density (BMD) tests measure bone density at various sites of the body. These tests can detect osteoporosis before a fracture occurs and predict one’s chances of fracturing in the future. Lupus patients, particularly those receiving glucocorticoid therapy for 2 months or more, should talk to their doctors about whether they might be candidates for a bone density test.

Medication: Like lupus, osteoporosis is a disease with no cure. However, there are medications available to prevent and treat osteoporosis. Several medications (alendronate, risedronate, ibandronate, raloxifene, calcitonin, teriparatide, and estrogen/hormone therapy) are approved by the Food and Drug Administration (FDA) for the prevention and/or treatment of osteoporosis in postmenopausal women. Alendronate is also approved for use in men. For people with lupus who develop or may develop glucocorticoid-induced osteoporosis, alendronate has been approved to treat this condition and risedronate has been approved to treat and prevent it.

Common medications for lupus

Standard

These medications will vary from person to person because lupus is different in each individual and only your doctor can decide what is the best line of treatment for your symptoms. This is just an overall guide. Some people will never have to take most of these drugs while others may have to take most of them at some point in their disease. This information is from the Lupus Foundation of America’s web page. Please refer to their page for more information.

Medications to Treat Lupus Symptoms

Anti-Inflammatories

Anti-inflammatory medications help to relieve many of the symptoms of lupus by reducing inflammation and pain. Anti-inflammatories are the most common drugs used to treat lupus, particularly symptoms such as fever, arthritis or pleurisy, which generally improve within several days of beginning treatment. For many people with lupus, an anti-inflammatory drug may be the only medication they need to control their lupus.

  • Aspirin is inexpensive and available over the counter. It has pain-reducing, anti-inflammatory, and anticoagulant (blood-thinning) properties that can control some of the symptoms of lupus. However, aspirin can cause stomach irritation.
  • Acetaminophen, known to most people as Tylenol®, is also used to reduce pain. Although it causes less stomach irritation than aspirin, acetaminophen does not help with inflammation and cannot control any of the disease activity of lupus. Most people have no side effects when taking Tylenol, but in rare cases acute liver failure has occurred.
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) suppress inflammation and are especially useful for joint pain and stiffness. Examples of NSAIDs are ibuprofen (Motrin®), naproxen (Naprosyn®), indomethacin (Indocin®), nabumetone (Relafen®), and celecoxib (Celebrex®). People often respond better to one particular NSAID than another, so you may need to try several different products to determine the most effective one for you.

Like aspirin, NSAIDs can cause stomach irritation. NSAIDs may also cause serious gastrointestinal (GI) complications, such as a bleeding ulcer. To reduce the chance of these problems, NSAIDs are usually taken with food, milk or antacids, or may be accompanied by other medications such as misoprostol (Cytotec®), omeprazole (Prilosec®), lanzoprazole (Prevacid®), and others.

Side effects of NSAIDS, such as abnormal urine test results, occasionally may be mistaken for signs of active lupus. Recognizing this possible complication of NSAID use is important, because the symptoms will go away when the drug is stopped. In general, you should always be cautious about taking too much of any NSAID, as excessive amounts can reduce the blood flow to your kidneys and may interfere with their ability to remove waste from your body.

Corticosteroids

Corticosteroids (also known as glucocorticoids, cortisone or steroids) are synthetic (man-made) drugs designed to work like the body’s naturally occurring hormones produced by the adrenal glands, in particular cortisol. Hormones are the body’s chemical messengers that regulate most of the body’s functions. Cortisol helps regulate blood pressure and the immune system, and it is the body’s most potent anti-inflammatory hormone. Corticosteroids prescribed for autoimmune diseases are different from the anabolic steroids that weightlifters and other athletes sometimes take to increase strength.

Steroid medications work quickly to decrease the swelling, warmth, tenderness, and pain that are associated with inflammation. They do this by lessening the immune system’s response. Prednisone is the most commonly prescribed steroid for lupus. Prednisolone and methyl-prednisolone (Medrol®) are similar to prednisone, and some physicians prefer to prescribe these if you have liver problems.

Most people take steroids in pill form, but topical creams or gels are often used for cutaneous (skin) lupus. Steroids in liquid form are sometimes injected into muscles or directly into joints, and in some cases into skin lesions. Pulse steroids are large liquid doses given intravenously (injected into a vein) over several hours; the beneficial effects can last for weeks so pulse steroids are sometimes prescribed to control a lupus flare, or for people who cannot tolerate steroids in pill form.

Your doctor will try to keep your steroid dosage at the lowest effective level. Once the symptoms of lupus have responded to treatment, the steroid dose is gradually reduced (tapered). As an alternative to tapering, or stepping down the steroid dose, your doctor may choose to have you take steroids on an every-other day basis — one day on, one day off.

Steroids can produce a variety of side effects. The most common are changes in appearance (acne, a round or moon-shaped face, weight gain due to increased appetite, and hair growth). Steroids can cause fluid retention and a redistribution of fat, leading to a swollen face and abdomen, but thin arms and legs. Also, the skin becomes more fragile and bruises easily. Steroids can suppress growth in children. Steroids can also cause irritability, agitation, excitability, insomnia, or depression. These changes in appearance and mood are more apparent with high doses of steroids.

Side Effects of Long Term Steroid Use

  • Increased risk of infections poses the most danger. If you are taking steroids you must take extra care to clean and protect any open wounds. Infections are one of the leading causes of death in people with lupus.
  • Avascular necrosis of bone, which occurs most often in the hip, is the destruction of the bone itself and is quite painful. Relief from pain often requires total surgical joint replacement.
  • Osteoporosis (bones become fragile and more likely to break) leads to bone fractures, especially compression fractures of the vertebrae with severe back pain.
  • Muscle weakness
  • Cataracts
  • Suppression of growth in children

Antimalarials

Antimalarials are used in combination with steroids and other medications, in part to reduce the dose required of the other drugs. Antimalarials are most often prescribed for skin rashes, mouth ulcers, and joint pain, but also can be effective in mild forms of lupus where inflammation and blood clotting are a concern. Antimalarials improve lupus by decreasing autoantibody production, protecting against the damaging effects of ultraviolet light from the sun and other sources, and improving skin lesions.

The two types of antimalarials most often prescribed today for lupus are hydroxychloroquine (Plaquenil®) and chloroquine (Aralen®). Unlike the rapid response seen with steroids, it may take months before antimalarial drugs improve your lupus symptoms.

Side effects from antimalarials are rare and usually mild; they include upset stomach and changes in skin color. These side effects usually go away after the body adjusts to the medication. In high doses certain antimalarial drugs may damage the retina of the eye, causing vision problems. With the low doses of antimalarials used in the treatment of lupus, the risk of this complication is extremely low. However, as a precaution, people treated with antimalarials should see an eye doctor (ophthalmologist) regularly.

Women who are pregnant should continue to take their antimalarial medication as prescribed, in order to avoid a lupus flare. Although this medication can cross the placenta, the possibility of eye and ear toxicity in the infant is very low. In fact, recent studies suggest that the risk of flare for the mother is greater than the risk of fetal toxicity.

Immunosuppressives (Immune Modulators)

Immunosuppressive medications are used to control inflammation and the overactive immune system, especially when steroids have been unable to bring lupus symptoms under control, or when a person cannot tolerate high doses of steroids. However, there can be serious side effects from these drugs, so if you are being treated with immunosuppressives you should be carefully monitored by your physician. Immunosuppressive drugs reduce your body’s ability to fight off infections, and increase the chances that you could develop viral infections such as shingles (chicken pox, or herpes zoster). It is extremely important that you pay attention to even the smallest cut or wound, and let your doctor know if any sign of infection begins, such as redness, swelling, tenderness, or pain. These drugs may also increase your risk for developing cancer.

Each immunosuppressive drug has unique side effects. Therefore it is important that immunosuppressive drugs be given only by physicians who are experienced with the use of these medications.

Cyclophosphamide (Cytoxan®) was developed to fight cancer. Although in its early years of use it was taken in pill form, today Cytoxan is taken through the vein (intravenously, or IV). It has been shown to improve kidney and lung disease, but can affect a woman’s menstrual cycle and can cause bladder problems, hair loss, and sterility.

Methotrexate (Rheumatrex™), also developed to fight cancer, is known as the “gold standard” — the best drug — for the treatment of rheumatoid arthritis. It has also been shown to be very effective in treating skin lesions, arthritis, and pleuritis in people with lupus. However, the drug can cause sun-sensitivity, liver damage, including cirrhosis, and lung infections. If you are taking this drug you should not drink alcohol, especially if you have a history of kidney disease. If you are taking high-dose methotrexate you should not use NSAIDs; caution is also advised when taking aspirin. Nausea, mouth sores, and headaches are the most common side effects of methotrexate.

Azathioprine (Imuran®) was developed to prevent rejection of kidney transplants. It blocks inflammation pathways in lupus and helps to lower the steroid dosage and improve liver and kidney disease. However, it may cause pancreatitis and an allergic form of hepatitis, so liver function tests and blood counts should be done regularly.

Anticoagulant

Because blood clots can be a life-threatening symptom of lupus, these drugs are used to thin your blood to prevent it from clotting too easily. Anticoagulant medications include low-dose aspirin, heparin (Calciparine®, Liquaemin®) and warfarin (Coumadin®). In particular, if you are being treated with warfarin you must be monitored by your doctor to be sure your blood does not become too thin. Anticoagulant therapy may be lifelong in some people with lupus. Very recent research has shown that people’s genetic makeup may influence how they respond to warfarin; specifically, that people with variations in two genes may need lower warfarin doses due to differences in how the body breaks down (metabolizes) warfarin and regulates the ability of warfarin to prevent blood from clotting. Therefore the dosage and administration of warfarin must be individualized for each person.

Frequently Asked Questions

 

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 side effects can I expect from taking steroids?
Prednisone is a double-edged sword. It is a very effective anti-inflammatory agent in lupus, and it works fast. But over time, the side effects of higher doses of the medication can be significant. People taking steroids may have side effects that include weight gain (especially in the cheeks and over the back of the neck), acne, hair thinning on the scalp, new facial hair (on the chin or above the lips), mood swings and difficulty concentrating. Your doctor may also discover that your prednisone has caused higher blood pressure, higher glucose levels and higher cholesterol. Prednisone can also weaken bones and damage the blood supply to joints, which usually occurs first in the hips.

Does long-term prednisone use cause diabetes?
Cortisone and its analogues are “stress hormones” that prime the body for times of challenge. Thus, the rise in sugar in the body is a natural byproduct of a preparation for stress in tissues of the muscles, brain, and heart for example. This is why an increase in the stress hormone results in an increase of the body’s stores of glucose. Long-term prednisone use can cause diabetes in someone who has a tendency to be diabetic. Moreover, the higher the dose of prednisone, the greater the likelihood that the blood glucose (sugar) level will rise. Obesity and a genetic background that includes diabetes also gives a person a greater chance of developing diabetes.