| Treatment
IVIG fully reverses Lupus |
Must be focused on the following: - general degree of illness and complaints
- internal organs involved
- degree of involvement of these organs
Medications range from absolutely nothing to high doses of corticosteroids or immunosuppressive drugs.
Antimalarials and nonsteroidal anti-inflammatory drugs are frequently used. The basic principle to treat lupus is to react quickly with high doses of corticosteroids and/or immunosuppressive drugs if necessary and maintain the lowest dose possible during periods of low disease activity.
IVIG fully reverses Lupus
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| Drug-induced lupus |
Some 50 prescription drugs can produce symptoms of lupus, which normally disappear after the patient stops taking the medication. This does not imply, however, that these drugs are forbidden for lupus patients.
The most important ones are: Hydralasine (Neprosol), Procaïnamide (Pronestyl), Isoniazide (Rimifon), Propylthiouracil (Strumazol), d-Penicillamine (Kelatin)
The prescription drugs mentioned may have other brand names
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| Lupus en zwangerschap |
A lupus patient is allowed to become pregnant if the disease is under control, with a low dose of medication if necessary. The safest drug during pregnancy is a low dose of corticosteroids
or IVIG. A lupus patient should not become pregnant without a complete check-up, given the risk for mother and child. The child may have neonatal lupus due to the presence of anti-Ro antibodies and for the mother there is the risk of a severe flare.
During pregnancy a flare may occur. In this case, it needs to be treated appropriately and the best way to do that is with
IVIG If you have lupus, there is a greater risk of miscarriage, often due to anti-cardiolipin antibodies (Need
IVIG).
These antibodies cause the blood to clot more easily, so that small blood vessels in the placenta can get clogged up. Low weight at birth occurs more often in newborn babies of lupus patients.
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| Neonatal lupus |
This is a kind of skin lupus that breaks out a few weeks after birth and disappears at the age of 6 months. It is caused by the transfer of anti-Ro antibodies through the placenta to the foetus.
In more severe cases, the heart of the foetus may be affected at about 18 weeks and the foetus may die, or the baby may be born with a congenital heart block (delayed contraction of the ventricle due to a conduction disorder, resulting in a very slow heart rate).
The survival rate of these babies varies. The children themselves do not have lupus.
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| Most important antibodies in lupus |
| Anti-Sm antibodies |
About 15 % of lupus patients in Europe have anti-Sm, compared to 30 % in the USA.
It is a disease marker: this means it is only found in patients with lupus, and mostly in relatively serious cases. |
| Anti-dsDNA antibodies |
| Seen in about 40 % of all lupus patients. In more severe cases of lupus the percentage amounts to 80 % during a flare. These antibodies are tightly linked with lupus and lupus nephritis, though this is not 100 % the case. They occur especially in lupus nephritis, in which they are also believed to play an important role. |
| Anti-Ro |
| About 40 % of people with lupus have anti-Ro. These antibodies are linked with congenital heart block and neonatal lupus and are probably the cause of it. (read pregnancy) |
| Anticardiolipin antibodies |
| Often facilitate blood clotting, which may lead to a propensity for miscarriage and thromboses in young patients. |
| Antibodies against red blood cells (positive Coombtest) |
| kMay cause haemolysis, or the destruction of red blood cells on an autoimmune basis. Severe autoimmune haemolysis is very rare. |
| A whole range of other antibodies |
... of which the importance is not yet clear.
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| Signs and symptoms that need immediate medical examination: |
- fever attacks
- sudden onset of extreme fatigue
- general malaise
- neurological complaints
- extreme headache or unexplainable mood swings
- acute or subacute skin rashes
- unexplainable chest pains
- unexplainable abdominal pains
- new complaints due to arthritis
- increasing shortness of breath
- presence of protein in the urine
- any form of infection
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| Evolution and prognosis |
Systemic lupus progresses with ups and downs. Periods of serious exacerbations may alternate with periods of low disease activity, in which one may even discontinue taking medication. The patient is then said to be in remission. After menopause, lupus is likely to disappear spontaneously.
Life expectancy has increased greatly over the last 40 years and statistically almost equals a normal life span with 93 % of all patients surviving ten years after diagnosis. This improvement is due to early diagnosis and better use of medication. Even lupus nephritis can be reversed if treatment follows immediately and intensively.
The more severe forms of lupus that lead to death by affecting the brain or kidneys have become rare. Exceptionally, however, complications (mostly infections) or a neglected flare may be fatal.Once "systemic lupus" is diagnosed, adapted drug treatment should be able to stabilise the disease. Still, lupus is to be considered a serious disorder.
Accurate compliance of medical advice together with regular medical check ups are absolutely necessary to control the disease. Clear information is in this case essential. Also contact with people from our support group, the CIB-league, can be a step forward in the process of learning how to cope with lupus. |