.. ations with a sun protection factor (SPF) of at least 15 and which block both UVA and UVB rays are recommended. Medical Treatment SLE is typically a disease which shows a fluctuating course characterized by long periods of relative inactivity (remission) punctuated by unpredictable flares of inflammation involving one or more organ systems (exacerbation). Fortunately for a majority of SLE patients, the symptoms are so mild as to require little or no specific treatment. The choice of therapy will therefore depend both on the nature as well as the severity of the symptoms.
The initial treatment of minor joint aches and pains may often consist of simple anti-arthritic medications sometimes known as non-steroidal anti-inflammatory drugs or NSAIDs. Skin rash can frequently be managed by avoidance of sunlight as well as the use of topical steroid creams as directed by the family physician. If the rash or arthritis is more troublesome, your doctor may consider a class of drugs still used for the treatment of malaria such as hydroxychloroquine or Plaquenil. For patients with more serious symptoms such as severe fever, pleurisy or pericarditis, or falling blood count, it may be necessary to resort to the use of corticosteroids by mouth for a variable length of time. Unfortunately corticosteroids have a variety of side effects and your doctor will endeavour to taper and reduce the dosage as quickly as is medically possible. A relatively new approach called pulse steroid therapy involves the administration of very large doses of corticosteroid either orally or intravenously over a short period such as 1-3 days.
Pulse steroid therapy would seem to have the advantage of being relatively free of immediate and long term side effects. For the rare patient where steroids are inadequate, treatment is available with a number of more potent drugs specifically directed at suppressing the formation of the abnormal antibodies which occur in SLE. These drugs, examples of which include Imuran and Cyclophosphamide, are called cytotoxic or immunosuppressive agents. These drugs are frequently effective but may have serious side effects including the suppression of the body’s normal ability to fight infection. An alternate non-drug approach to the management of SLE, especially severe kidney disease, may be sometimes considered. This procedure, which is called plasmapheresis, involves an exchange type transfusion whereby the red blood cells are removed from the blood and returned to the body while undesirable antibodies and complexes and the liquid part of the body’s blood (plasma) are discarded.
This treatment seems most effective when combined with one of the cytotoxic or immunosuppressive drugs. Follow-up As the course of SLE may be unpredictable, close medical follow-up is essential. This involves periodic assessment of disease activity by clinical history, physical examination and specific laboratory tests ordered by your doctor. Close follow-up during pregnancy and the immediate postpartum period is especially important as the risk of disease flare is increased during these periods. Inactive disease at the time of conception is associated with the best prognosis for both mother and baby.
There is a slight but definite increased risk of miscarriage in mothers with lupus and their babies may have an increased chance of being born premature or with low birth weights. Babies born to lupus mothers may also be at increased risk of developing lupus (neonatal lupus). This is probably due to the passage of abnormal antibodies through the placenta into the fetal blood stream. Neonatal lupus almost always resolves within 4-6 months of delivery. Babies born to lupus mothers may also be at increased risk of being born with an abnormality to the conduction system of the heart muscle.
This may or may not be associated with other signs of neonatal lupus and seems to correlate closely with a very specific type of antibody in the mother’s circulation called the anti-Ro antibody. Conclusions Although there is no specific cure for SLE, there is much room for optimism. Patients are now being identified far earlier and therapy, if necessary, is generally more effective. Moreover, as physicians have gained experience with the diseaseand its management, many of the past complications which often as not arose from overzealous treatment can now be avoided. More importantly, fundamental advances are being made in the understanding of the specific immune abnormalities in SLE, which undoubtedly will lead to steady improvements both in the management and the overall prognosis. TABLE 1 1982 Revised ARA Criteria for Classification of SLE* 1.Butterfly rash 2.
Discoid rash 3.Sun sensitive rash 4.Mouth ulcers 5.Arthritis 6.Pleuritis/Pericarditis 7.Kidney disorder 8.Brain or nerve disorder 9.Blood disorder 10.Presence of one or more antibodies to various body tissues 11.Presence of anti-nuclear antibodies (ANA) For the purpose of identifying patients, a person shall be said to have SLE if any 4 or more of the 11 criteria are present serially or simultaneously. Lupus Erythematosus Society of Saskatchewan – L.E.S.S. The Lupus Erythematosus Society of Saskatchewan Inc. is a voluntary association which is concerned about those people who are affected by Systemic Lupus Erythematosus. The primary goal of L.E.S.S. Inc. is to help its members become more informed about lupus so that through information they might assist in controlling their illness and learn to cope with the emotional effects of being chronically ill.
To further this aim, we sponsor meetings in several locations throughout the province, with a variety of professional speakers presenting information about lupus, current research or specific lupus problems and their treatments. In addition, we publish four newsletters each year which include reprints of reputable and current articles, summaries of guest speaker presentations, and information about our group and its members. We also attempt to provide opportunities for members to meet and share in a personal way as well as to offer support to those who are in need. Lupus is not rare and in Saskatchewan there are approximately 500 people who have the disease, either diagnosed or undiagnosed. To assist in supporting these people, L.E.S.S.
Inc. has groups currently operating in Saskatoon, Regina, Swift Current, Prince Albert and Hudson Bay, with contacts in Moose Jaw and North Battleford. If you are interested in obtaining information about lupus or about L.E.S.S. Inc., we would be pleased to hear from you. Bibliography Bibliography The Oxford Textbook of Rheumatology.
This 1500 textbook on immune disorders covers all phases of lupus and other associated immune disorders such as a sclerodoma, rheumatoid arthritis, Sjorjens syndrome, Chronic Fatigue Syndrome, Fibromyalagia, etc. The New England Journal of Medicine (published weekly) has had many excellent articles concerning lupus and other immune disorders and it references other sources of information in its bibliography. Chronic Fatigue List There is also a very nice Chronic Fatigue List which publishes a newsletter which information about fibromyalagia and cfs. Subscribe by E-mail to CFS-. Medicine and Health Care.