Treatment of Lupus
Although there is no curative treatment for lupus, this is effective in practically all cases. The aim is to control the disease with the lowest possible drug dose for the least possible time. In this way, the majority of patients can enjoy a normal life, from a family, occupational, and social point of view.
Information. The patients with lupus and their families must receive adequate and complete information about the disease in order for the patient to cooperate.
Walk, swim, or ride a bicycle. It is advisable to carry out these types of activities in order to prevent the muscle weakness that causes fatigue and alternate them with periods of rest. To carry out a physical activity also helps to cope with situations of physical and mental stress.
Avoid direct exposure to the sun and other light sources. Especially in patients with photosensitivity.
Balanced diet. There is no diet that protects or reduces the activity of the disease. It is recommended to eat foods with a low content of fat, salt, and sugar, and with a high fibre content. Those patients that are taking corticosteroids should limit their intake of sugar, fat and salt. Furthermore, if the kidney is affected or you suffer from high blood pressure, salty foods must be avoided.
Tobacco. Patients with lupus cannot smoke.
- Analgesic and anti-inflammatory drugs. These are used in patients with joint or muscular pains.
- Anti-malarial drugs. These are drugs prepared to cure malaria. They form the basic treatment and, apart from a contraindication (exceptional), all patients with lupus must be treated with anti-malarial drugs. The most used are hydroxychloroquine, mepacrine, and chloroquine sulphate.
- Corticosteroids. The most used is prednisone. They are very effective for reducing lupus activity. Due to the side-effects of the corticosteroids, the aim is to use them at the lowest dose possible and for the least time possible. The dose depends on the severity of the symptoms, and must be gradually decreased whenever possible, withdrawing them once the disease is under control.
- Immunosuppressive drugs. They are used in the most severe manifestations, such as kidney or brain involvement, or in those patients who do not tolerate corticosteroids. The most common are methotrexate, azathioprine, cyclophosphamide, and mycophenolate.
- Biological therapies. They are those that are prepared from human proteins or live cells, unlike those that are non-biological, that are prepared using a combination of chemical agents. They are currently used for severe cases that do not respond to conventional treatment (antimalarials, corticosteroids and immunosuppressants). The most used are belimumab and rituximab.
The most common complications of the treatment are those arising from the long-term use of corticosteroids and immunosuppressants.
Side-effects of corticosteroids
Doses equal to or less than 5 mg/day of prednisone are considered reasonably safe. Higher doses and for longer periods of time may cause:
- A higher risk of infections.
- Changes in the metabolic profile with high blood pressure.
- Increase in cholesterol.
- Diabetes and, thus, an increase in cardiovascular risk, osteoporosis and associated fractures.
- Increase in body hair.
- Increase in appetite and, as a result, of weight.
- Cushinoid appearance (moon face).
- Stretchmarks and skin atrophy, and peptic ulcer.
Side-effects of immunosuppressants
In general, all of them can produce:
- Increase in the risk of infections and neoplasms (tumours), especially with elevated doses of cyclophosphamides, although they may be minimised under strict clinical control.
- Changes in liver enzymes.
- A reduction in defence cells (white cells).
- Sterility problems, depending on the age of the patient and the accumulated dose of cyclophosphamide.
In recent years, there has been a considerable increase in the number of clinical trials of new treatments for patient with lupus. The majority are focused on new therapies directed at blocking molecules that intervene in key points of the mechanisms involved in the onset and development of the disease process. The advantage of these new treatments is based on that they are more specific and selective in their mechanism of action, thus, the profile of side-effects is much better than that of conventional treatments (especially corticosteroids and immunosuppressants).
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