LUPUS AND TREATMENT WITH DRUGS

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LUPUS AND TREATMENT WITH DRUGS
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Aims of Treatment

• The aim of drug treatment in Lupus is to treat
  the disease with minimal side affects from the
  drugs.
• We aim to make you feel as well as possible so
  that you can continue life as you would wish to.
• Although this is our aim it may take time to get
  the right combination of drugs. For this we
  require your help and patience.

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Ways of Treating You

• Over the years it has been found that the best
  way of making you feel better with the least risk
  of developing drug side effects may be to use
  several different drugs at lower doses rather
  than a single drug alone at higher doses.
• This means you may end up on several different
  drugs to take during the day.

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First Line of Treatment

• We give you different drugs depending on how ill
  you are.
• If you have mild Lupus we or you GP may start
  with Non Steroidal Anti Inflammatory Drugs such
  as Ibuprofen.
• You may also need other pain killers as well such
  as paracetamol.
• You should always use sunblock from April to
  October, especially if you get sun induced
  rashes.

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Anti Malarial Tablets

• If Anti Inflammatory Drugs are not enough then we
  often give antimalarial drugs next.
• This is usually Hydroxychloroquine. This
  particularly helps with joint pains and mild
  rashes.
• Most patients tolerate this drug well. Some
  patients may develop side effects such as nausea
  or allergic rashes. A rare side effect can be
  problems with the vision, although this is
  usually the result of other causes.

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Steroids

• This is the fastest acting treatment for Lupus.
• The dose given and the method of administration
  varies depending on how bad your symptoms are.
• Our aim is to give the smallest dose possible
  while keeping your Lupus under control.

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Steroids Continued

• The steroid we use is different to the one you
  read about athletes taking.
• It is dangerous to stop steroids suddenly. They
  must be reduced gradually under medical
  supervision.
• Steroids can be given as creams, ointment, eye
  drops or injections into the joints, muscles or
  veins.

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Steroid Sparing Drugs

• If we cannot get your dose of steroids down, or
  if you have required drips of steroids or other
  drugs. We will then recommend other drugs to keep
  your Lupus under control.
• The drug we choose to put you on depends on your
  symptoms, blood results and whether or not you
  plan to become pregnant.
• These drugs usually take 12 weeks to have an
  effect on your Lupus. Therefore you use them in
  combination with steroids or other drugs.

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What are the steroid sparing drugs?

• Azathioprine is one of the most commonly used
  drugs that we use to help reduce the steroid
  dose.
• It can be used in pregnancy and breast feeding.
• We sometimes do not use it if there are concerns
  about a low white cell count (blood cells that
  fight infection). However, this depends on the
  cause of the low count.

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Cyclosporin

• Cyclosporin is usually used in patients who
  cannot use Azathioprine to reduce the steroid
  dose.
• Sometimes we cannot use it if there are certain
  problems with the kidneys or high blood pressure.
• Can be used in pregnancy.

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Methotrexate

• Methotrexate is particularly good for arthritis
  symptoms.
• It is only taken once a week
• It cannot be used in pregnancy or while breast
  feeding.

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Mycophenolate mofetil (MMF)

• Good for many Lupus symptoms, although it is
  still being tested
• Appears to be good when Lupus has not responded
  to other treatments.
• You should not get pregnant while taking this
  this drug. There is a risk of congenital
  abnormalities in the baby.
• This drug is not yet routinely available.

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Blood Tests

• You need regular blood tests while taking steroid
  sparing drugs.
• These tests are usually done once every two weeks
  to begin with, until you are established on the
  drug.
• The blood tests are then done monthly to 3
  monthly until you stop the drug.
• These blood tests are important as they show
  problems that you will not be aware of until you
  are very sick due to side effects on the bone
  marrow (where blood cells are made), the liver or
  kidneys.

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Drips or Pulses

• The main two drugs we use as drips or pulses are
  steroids and cyclophosphamide.
• These are used when you Lupus is severe and we
  want to get it under control quickly.
• Once under control we can consider other
  treatments for long term use.
• You must not get pregnant whilst been treated
  with cyclophosphamide as it causes abnormalities
  in the unborn baby.

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Ways of treating yourself

• From April to October you should wear a sun
  block. Factor 25 or above. You can get this on
  prescription.
• Fatigue is a constant problem for many Lupus
  patients. It is important to balance rest, work
  and gentle exercise.
• Keeping your weight within recommended limits on
  a low fat diet will help, particularly with joint
  pains. It will also reduce the risk of heart
  disease in later life.

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Alternative Therapy

• The only alternative therapies that we do not
  recommend are herbal treatments and Chinese
  medicine. These can react with conventional
  treatment and cause liver and kidney problems.
• St Johns Wort also interacts with many of the
  drugs used for Lupus.
• Other alternative therapies are considered safe,
  but the potential benefits are uncertain. For
  example acupuncture, shiatsu, massage,
  reflexology or homeopathy.
• Please discuss any forms of therapy that you are
  having or considering with the doctor or nurse in
  clinic.

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Final Comment

• This is only an outline of how we choose which
  drugs to treat your Lupus.
• If you have comments or strong feelings about
  your treatment please discuss this with your
  Lupus doctor.
• If you have other questions or comments please
  discuss them with me
• Kate Peers, Lupus UK funded Nurse
• Phone numbers 0121 414 6875 or 0776 558 7885
  Works Tuesday to Friday 8am - 4pm