How do rheumatologists think when it comes to the management of your Lupus and what you should know?
Updated: Oct 16
In this blog we will explore the management of lupus, shedding light on both lifestyle strategies and medications that can help patients lead healthier lives. As always, we hope this is educational. Please talk with your rheumatologist as these are not medical advice. If you are looking for a rheumatologist in Colorado, contact us at info@unabridgedMD.com
Understanding Lupus Diagnosis
In our previous episode, we discussed how lupus, or systemic lupus erythematosus (SLE), is a complex autoimmune condition where the body's immune system mistakenly attacks its own tissues and organs. SLE cannot be solely diagnosed based on blood work, as it requires a combination of symptoms and diagnostic tests. SLE can affect various organs, including the joints, skin, vessels, nerves, lungs, heart, and kidneys. Some of SLE key symptoms and signs to look out for are joint pain, skin rashes (including the characteristic butterfly rash), Raynaud's phenomenon, alopecia (hair loss), vasculitis, neurological symptoms, lung involvement, heart issues, and kidney problems. To confirm a lupus diagnosis, doctors typically assess blood work, including ANA, DS DNA, Smith antibodies, C3, and C4 levels. However, some patients may have a negative ANA but still exhibit lupus-related tissue damage, necessitating a kidney biopsy.
All in all, it is important to remember that the classification criteria for Lupus are for research purposes and that the clinicians make a diagnosis based on the presentation of their patients.
Understanding Lupus Flares and Prevention:
Lupus management revolves around controlling inflammation and preventing disease flares. We emphasize that patients can play an active role in managing their condition. Here are key strategies for preventing lupus flares:
Avoid sun exposure, wear sunscreen with SPF 60 or higher, use protective clothing like wide-brimmed hats, and minimize time outdoors during peak sunlight hours.
Quit smoking, If you have SLE, quitting is something you should consider both in the short term and especially in the long run. Although it can be challenging, it's worth it. A quick reminder that patients with SLE who smoke and use Hydroxychloroquine do not allow full efficacy for the HCQ to work if they use tobacco products. Quitting is worth it!
Avoid Stress, Practice stress reduction techniques such as mindfulness, meditation, deep breathing, and relaxation exercises to help mitigate stress-related flare triggers. You should take time, and energy to actually do meditation. I recommend meditation every day for at least 10 minutes per day. I do it because I see the difference. And there are so many studies that are showing that it really does help.
Make sure that you're well hydrated.
There are some studies that show that having a balanced diet is also helpful. So those are all things that you can do.
Medications in Lupus Management:
Lupus medications aim to restore the body's immune system balance. Different drugs are used depending on the severity and type of lupus symptoms. Here are some insights into several medications used in lupus treatment:
Plaquenil (Hydroxychloroquine): It has been proven to be effective for lupus. Numerous studies, including some in which I participated, have demonstrated that drugs like Plaquenil (or hydroxychloroquine) can help prevent lupus flares. Everyone that does not have a contraindication for Plaquenil/hydroxychloroquine should be on it. A reminder that Plaquenil is not immunosuppressive but rather is an immunomodulator
We typically resort to using them when the situation needs it. Many individuals diagnosed with SLE may not require these medications. For many, Plaquenil alone can be enough for them.
Steroids ( such as Prednisone, Methylprednisolone). Sometimes you have to be on steroids because you have life-threatening or organ damage that we want to reverse as fast as possible. They are effective but come with potential side effects, so they are typically used for a limited time
Then we have conventional Immunosuppressants such as Azathioprine, Mycophenolate Mofetil, and Methotrexate: These drugs suppress the immune system's hyperactivity, reducing inflammation. All of these medications are, in a general sense, reducing your immune system, and they belong to the oldest class of drugs.
We now have newer drugs, called biologics including Belimumab (benlysta) or Anifrolumab- (SAPHNELO)..These are newer medications that work well, especially for patients who have joint and skin involvement. They are often better tolerated than the older immunosuppressive agents and also more effective.
In severe cases of SLE you may need Cytoxan which is a chemotherapeutic drug and can be very helpful if you have severe SLE.
Striving for Remission:
The ultimate goal in lupus management is achieving remission, which means the absence of symptoms on treatment and to prevent flares. While lupus may not be curable, it can be effectively managed to the point where patients experience no active disease manifestations. Achieving this balance between symptom control and medication management is crucial for long-term health and well-being.
Understanding lupus, both in terms of diagnosis and management, is essential for patients and their healthcare providers. By following sun protection measures, quitting smoking, practicing stress reduction techniques, staying hydrated, and working closely with their medical team to find the right combination of medications, individuals with lupus can lead fulfilling lives while managing their condition effectively.
If you have any questions or need further information about lupus or rheumatology, don't hesitate to reach out to us at info@UnabridgedMD. The journey to lupus management may be challenging, but with the right strategies and a supportive medical team, individuals can thrive while living with lupus. Remember, remission is the goal, and it's within reach for many patients.
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