Clinical Immunology focuses on the immune system’s health. Learn about the diagnosis and treatment of allergies, autoimmune diseases, and immunodeficiencies.

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Lupus: Treatment and Management

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The management of lupus has evolved significantly, transforming a once fatal condition into a manageable chronic disease. The primary goals of treatment are to suppress the overactive immune system, induce remission, prevent organ damage, and improve quality of life. Treatment plans are highly personalized, based on the severity of the disease and the specific organs involved. A combination of medications, lifestyle modifications, and regular monitoring forms the backbone of adequate care.

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Corticosteroids

IMMUNOLOGY

Steroids (like prednisone) are the “firefighters” of lupus treatment, used to control inflammation rapidly.

  • Acute Management: Used in high doses during severe flares to save organs like the kidneys or the brain.
  • Bridging Therapy: Prescribed while waiting for slower-acting maintenance drugs to take effect.
  • Tapering: The goal is always to taper down to the lowest effective dose or discontinue them to avoid side effects.
  • Side Effects: Long-term use can lead to weight gain, osteoporosis, high blood pressure, and increased infection risk.
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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

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For mild lupus involving primarily pain and stiffness, NSAIDs are often the first line of defense.

  • Usage: Drugs like ibuprofen or naproxen help manage joint pain, muscle aches, and pleurisy (chest pain).
  • Caution: Use with care in patients with kidney involvement, as it can reduce blood flow to the kidneys.
  • Gastric Protection: Long-term use requires monitoring for stomach ulcers or bleeding.
  • Heart Risks: Patients with cardiovascular risk factors should use them sparingly.

Antimalarial Medications

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The Anchor Therapy

Hydroxychloroquine (Plaquenil) is the foundational medication for nearly all lupus patients, unless contraindicated.

  • Mechanism: It modulates the immune system without suppressing it excessively, blocking pathways that lead to inflammation.
  • Benefits: Reduces flares, treats skin and joint symptoms, prevents organ damage, and lowers the risk of blood clots.
  • Long-term Use: It is typically continued indefinitely, even during pregnancy.
  • Monitoring: Requires regular eye exams to monitor for rare retinal toxicity.

Benefits Beyond Symptom Control

Antimalarials provide systemic protection that extends life expectancy.

  • Lipid Profile: Helps improve cholesterol and glucose levels.
  • Thrombosis Prevention: Offers a mild anti-clotting effect.
  • Mortality Reduction: Studies show it significantly reduces mortality in patients with lupus.

Immunosuppressants

When lupus threatens major organs or steroids cannot be tapered, more potent immune-suppressing drugs are added.

  • Methotrexate: Commonly used for arthritis and skin disease that doesn’t respond to antimalarials.
  • Azathioprine: A maintenance drug often used to keep the disease in remission after a flare.
  • Mycophenolate Mofetil: The standard of care for lupus nephritis, effectively preserving kidney function.
  • Cyclophosphamide: A potent chemotherapy drug reserved for the most severe, life-threatening organ damage (e.g., severe nephritis or vasculitis).

Biologic Therapies

Biologics are targeted therapies that focus on specific parts of the immune system rather than suppressing the whole system.

  • Belimumab: The first drug specifically approved for lupus. It inhibits a protein (BLyS) that stimulates B-cells (antibody-producing cells).
  • Anifrolumab: Targets the type I interferon receptor, a pathway highly active in lupus, particularly effective for skin disease.
  • Rituximab: A B-cell depleting agent used “off-label” for severe cases that do not respond to other treatments.
  • Administration: These are given via intravenous infusion or subcutaneous injection.

Managing Comorbidities

Treating lupus involves managing the conditions that often accompany it.

  • Osteoporosis: Calcium, Vitamin D, and bisphosphonates are prescribed to counteract bone loss from steroids and inflammation.
  • Hypertension: Aggressive blood pressure control is vital to protect kidneys and the heart.
  • Cardiovascular Risk: Statins and aspirin may be used to manage the high risk of atherosclerosis and clots.
  • Infection Control: Prophylactic antibiotics may be needed for patients on heavy immunosuppression.

Pregnancy and Reproductive Health

Lupus requires careful planning regarding reproductive health.

  • Planning: Pregnancy is safest when the disease has been in remission for at least six months.
  • Medication Adjustment: Teratogenic drugs (like mycophenolate) must be switched to pregnancy-safe alternatives (like azathioprine) before conception.
  • Monitoring: High-risk obstetrics care is needed to monitor for preeclampsia and fetal health.
  • Contraception: Estrogen-containing birth control is often avoided in patients with antiphospholipid antibodies due to clot risk.

Why Choose Liv Hospital

At Liv Hospital, we champion a “treat-to-target” strategy. This means we set specific remission goals and aggressively adjust therapy until those goals are met. Our access to the latest biologic therapies and clinical protocols ensures that you receive cutting-edge care. We prioritize medication safety, offering robust monitoring programs for potential side effects. Our team also includes specialized dietitians and physical therapists who work alongside your rheumatologist to enhance your treatment plan, ensuring that your body is supported comprehensively while fighting the disease.

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FREQUENTLY ASKED QUESTIONS

Why do I have to take hydroxychloroquine if I feel fine?

It is a preventive medication. Taking it reduces the risk of future flares and organ damage, even when you have no symptoms.

High doses often cause increased appetite and fluid retention, leading to weight gain. Lowering the dose usually helps reverse this.

Biologics increase the risk of infection since they suppress the immune system, but they are generally safe when monitored by a specialist.

You should never stop medication without a doctor’s advice. Usually, doses are lowered gradually, but maintenance therapy is often kept to prevent relapse.

Yes, immunosuppressants can make it harder to fight infections. You should report fevers to your doctor immediately.

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