Current Treatment for SLE
Is there a cure for Lupus?
While there is at present no cure for lupus, there is hope of better medications becoming available within the next 10 years, which will produce the desired benefits without so many of the undesirable side effects. Currently lupus can be successfully controlled in the majority of cases via careful monitoring by a rheumatologist and other specialists as appropriate, careful adherence to avoiding triggers, and medication which is adjusted according to need. Statistically, 80-90% of people with lupus will live a normal life span. In addition, there are a small number of lupus patients who appear to go into complete remission indefinitely. This is a vast improvement over out-of-date statistics cited in many older lupus books. Further, lupus is NOT necessarily a progressive disease. Thus, the goal early in the course of treatment is to do the most good while doing the least harm, and also to prevent irreversible major organ damage. While finding a complete cure for lupus and lupus related diseases may be difficult due to the complex genetic patterns and wide variability in these diseases, the vast majority of lupus patients can expect to live long, full lives. It is important to note that different patients can have different responses to any treatment.
To TopI've heard about a Breakthrough
There are many individuals and groups that claim to have effective treatments or even cures for SLE. Their methods may be helpful or dangerous. There are numerous people who will claim that eating the right herbs, or acupuncture, or wearing magnets, or control of diet, or having the correct mental attitude will cure this disease. While some of these techniques may help some people, it is important to recognize that we are all unique and what helps one person might cause a flare in another. Of course, if you are desperate to help a loved one anythingwill seem worth trying, but treat all such claims with caution - and notify your doctor if you intend to try one of these nontraditional treatments instead of or in addition to what has been prescribed.
Some popular over-the-counter (OTC) treatments that are questionable as to their safety and efficacy in treating lupus symptoms are: Noni juice, Echinacea, and Licorice. There are many more. Many of these supplements can be dangerous in large amounts. In general, anything that is touted as an "Immune System Stimulant" (such as Echinacea) might be counterproductive as the goal in traditional therapy is to reduce immune system function to control lupus. Noni Juice contains large amounts of potassium which can be dangerous for patients with heart conditions and other health problems. Licorice has been shown to have adverse effects when used in large doses. High protein supplements can put a strain on the kidneys and therefore should be avoided by lupus patients with kidney involvement unless otherwise advised by their doctor. Before using any therapy, research it thoroughly and do not take the seller's word as absolute truth.
**Do NOT Stop Steroid Treatment Unless Your Doctor Agrees** Doing so can be life-threatening. Steroid tapering must be done under the supervision of your doctor
To TopCurrent traditional treatments for Lupus.
The term "traditional" refers to those methods generally accepted by the medical community. Treatments not in this category are often referred to as "alternative".
The current traditional therapies that are not experimental are:
- NSAIDs: The most common NSAID is Aspirin. But in recent years many new NSAIDs have been added to the medical arsenal. These include Naproxen, Ibuprofen, and the more recent additions, the COX-II Inhibitors.
- Steroids: These can be brief treatments for acute conditions or long-term treatment to control chronic illness.
- Anti-Malarials: The most common such drug is Plaquenil (generic: hydroxychloroquin). This drug is a relatively mild treatment and is intended for long-term control of disease. Variations on Plaquenil are sometimes used when a patient can not tolerate Plaquenil. There are some risks to the eyes from this medication. See Eye Conditions in Lupus.
- Chemotherapeutic Drugs: Drugs that are used to fight cancer are often used to help control lupus though the two diseases are not related. These include Imuran, Methotrexate and Cytoxan. These are powerful drugs but can be key to controlling moderate to severe disease.
- Physical Therapy: As muscle and joint pain is often present in SLE, physical therapy can be helpful to some patients.
- Symptomatic Control Medications: Medications that do not control the disease but instead control the symptoms. Examples would be pain medications (Ultram, Hydrocodone and other codeine derivatives, NSAIDs), sleep medications, gastrointestinal treatments and so on.
New Treatments for Lupus.
New Medications
Several new medications have been added to the lupus treatment arsenal in the past two years. Some of the new drugs are categorized as DMARDs - Disease Modifying Anti-Rheumatic Drugs. These include Arava, Remicaid and Enbrel. New anti-inflammatory drugs have also been approved: Celebrex and Vioxx being the best known. These new medications can be very helpful to certain patients. As with any medication, they have their drawbacks. Discuss any medication changes with your doctor. The DMARDs can damage the liver and cause other severe adverse reactions. Celebrex and Vioxx - in the class of drugs known as "COX-II inhibitors" - can cause severe allergic reactions in people sensitive to sulfonamides a.k.a. "sulfa" drugs. Many lupus patients are highly sensitive to sulfa drugs.
As of this writing, DHEA in its refined, patented form is still awaiting approval from the FDA. DHEA is available over-the-counter (OTC) but concentrations vary greatly from one manufacturer to another and most doctors do not recommend using over-the-counter DHEA. DHEA is a precursor to testosterone. While it appears to help some patients with symptoms, it can cause adverse side effects. Do not take DHEA without discussing it with your doctor first. For More information on DHEA go to http://cbshealthwatch.aol.com/cx/viewarticle/232995_1
It has recently been found that Thalidomide can be particularly effective against skin manifestations of SLE. Obviously, it is vital to ensure that the patient is not, and does not become, pregnant during the treatment. For more information on Thalidomide go to http://cbshealthwatch.compuserve.com/viewarticle/224707
New Therapies
Hematopoietic (blood cell forming) Stem Cell Transplant or HSCT is a relatively new procedure in Phase 2 clinical trial in the USA for treatment of SLE. In simple terms: stem cells (See Glossary) are harvested from the patient (either from blood or from bone marrow) and preserved. The patient then undergoes massive doses of chemotherapy (immunosuppression) to remove all traces of the original immune system. The preserved stem cells that were harvested are then reintroduced into the patient. The intent is to "reset" the immune system to its newborn state.
HSCT results in the loss of all childhood immunizations leaving the patient susceptible to re-infection. However, there is anecdotal evidence from the clinical trial that suggests that re-immunization (repeating childhood vaccinations such as diptheria, and rubella) causes relapse of the patient (recurrence of SLE). Otherwise, the treatment appears promising for patients with severe SLE. It is not a cure but has the potential to put patients into indefinite remission. Patients must meet strict criteria to be eligible for HSCT. "A profile of the patient who might be considered as a candidate for autologous stem cell transplantation includes evaluating life-threatening disease, inadequate response to aggressive immunosuppressive therapy, and adequate function of major organs to minimize risks. In carefully selected patients, the potential benefits of the [HSCT] may outweigh the risks." Kat Hammons, HSCT patient in remission without need of disease modifying medication.
HSCT as it is being performed now uses autologous (from the patient) stem cells only.
To TopProblems Associated with Lupus Treatments.
As with all treatments - traditional or alternative - "Your mileage may vary" However, there are known risks to many of the drugs and therapies used in treating Lupus and it's symptoms or related syndromes. The following is not comprehensive but intended to provide a starting point for investigation into these risks. Patients are not always properly advised about their medications. More information on these treatments is given above.
Non-steroidal Anti-Inflammatory Drugs
Non-steroidal Anti-Inflammatory Drugs (NSAIDS): The major problem associated with NSAIDs is gastrointestinal upset. The COX-II inhibitors are considered less prone to this side effect though in some patients they can still cause GI problems. Another risk associated with NSAIDs is liver damage. Lupus patients (and any patient taking NSAIDs regularly) should be monitored at least yearly for potential liver damage caused by these and other medications.
Anti-Malarials
Damage to the retina is possible with Plaquenil (Hydroxychloroquin) but monitoring by a qualified opthalmologist can catch changes early and cessation of the drug can stop further damage. It is recommended that a patient on Plaquenil get semi-annual (every 6 months) eye exams including a visual field test. Some anti-malarials can cause skin discoloration or depigmentation. They can also cause mild stomach upset and should be taken with food.
Disease Modifying Anti-rheumatic Drugs
Disease Modifying Anti-rheumatic Drugs (DMARDs): DMARDs. In general these are newer drugs with limited use and must be monitored more closely than NSAIDs. Risk is largely to the liver. See more above New treatment for Lupus
Steroids
Steroids have been part of Autoimmune treatment for decades. Steroids are given usually in excess of what the human body is capable of manufacturing for itself. Long term use of steroids can therefore shut down function of the adrenal glands. This is why sudden cessation of steroids can be very dangerous. Steroids typically cause water retention, weight gain, carbohydrate cravings, bone loss, avascular necrosis (AVN), muscle loss, Cushing's Syndrome and other, more cosmetic side effects. Steroids suppress the immune system by necessity and as such put the patient at risk of opportunistic infections. It should be stressed however that in some cases the risk of these side effects is outweighed by severe symptoms that will respond almost exclusively to steroids.
Chemotherapeutic Drugs
As one might guess, the risks associated with chemotherapeutic drugs in treating Lupus are similar to those risks associated in treating cancer. Immune system suppression (again, by necessity) increase risk of opportunistic infection. Wasting, anorexia, and other tissue deterioration is a risk. Specifically, oral Cytoxan, a treatment that has fallen into disfavor, poses a high risk of causing bladder cancer years down the line from treatment. Cytoxan IV (intravenous) treatment is considered safer on the bladder and medications can be given to reduce this risk.
Human Stem-Cell Transplant
This treatment is still experimental and is too complex to include here in terms of it's risks - essentially it's risk lie in the complete destruction of the immune system in order to "reset" it. For more on HSCT see above "New Therapies" under New treatment for Lupus
To Top