What is lupus?
Lupus, also known as systemic lupus erythematosus (SLE), is a chronic, multisystemic autoimmune disease, in which the immune system attacks the tissues all over the body, causing a wide array of symptoms. Symptoms include a butterfly-shaped rash on the face, oral ulcers, fever, fatigue, chest pain and joint pains. Occasionally, lupus is life-threatening when it involves the kidneys, lungs and heart. Lupus is not uncommon in Malaysia and 90% of them are women. Due to the variable disease courses, the diagnosis and treatment of lupus are challenging. Although there is no cure for lupus, effective lupus treatment options are available.
Generally, treatments for lupus are managed conservatively and pharmacologically. Conservative interventions are important to prevent disease “flare” or recurrence, keeping lupus under control. Less active disease means less organ damage and less need for medications. If you have lupus, do heed this advice closely.
- Protect yourself from sunlight. Since ultraviolet (UV) light can trigger or worsen the disease, avoid direct exposure or reflected sunlight. Put on sunscreen that can block UV-A and UV-B and has a sun protection factor (SPF) of more than 55.
- Stop smoking. Toxins from cigarette smoke are associated with more active disease. While individuals with SLE already have a higher risk of getting a heart attack, smoking can further increase that risk. Studies also showed that smoking reduces the effect of certain lupus medications.
- Obtain a balanced diet. A balanced diet that includes the right proportion of carbohydrates, protein, fat and fiber as well as minerals and vitamins. Individuals with lupus often require more calorie intake during an active disease. Vitamin D is also recommended as individuals with lupus have less exposure to sunlight, which normally produces vitamin D. Vitamin D is vital for our bones, teeth and immune system. If you have hypertension or lupus-related kidney problems, salt intake should be reduced.
- Exercise. Perhaps the most cliche advice, staying active helps to maintain muscle mass, prevent bones weakening and improve symptoms like fatigue. Low impact aerobic exercises are recommended such as brisk walking, cycling and swimming.
- Immunisations. Due to the nature of treatments for lupus involving suppressing the immune system, it is advisable to receive appropriate vaccines before the treatment. Do take note that the human papillomavirus (HPV) vaccine and hepatitis B vaccine have been shown to be safe and effective in individuals with stable lupus.
- Contraception. Avoid pregnancy during active disease as there is a high risk of miscarriage and worsening of the disease. Practice contraception until the disease has not recurred in at least 6 months.
- Inform your doctor. If you are undergoing any therapies or taking any medications aside from the lupus medications, inform the doctor about your lupus as certain procedures and drugs may trigger the disease.
For pharmacological treatment, doctors often prescribed hydroxychloroquine or chloroquine, medications that are normally used to treat for malaria. These are given as initial therapy because there is evidence that it improves many symptoms of lupus, as well as reducing the rates of recurrence, organ damage and mortality. 80% of individuals with lupus successfully achieve remission after taking these antimalarial medications. Hydroxychloroquine has also been shown to have a positive impact on the survival rate.
Sometimes, nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids are given to reduce the inflammation and relieve pain. Although steroids are good in reducing inflammation, it should only be used for short-term due to the long-term side effects. To control the disease, doctors may prescribe steroid-sparing immunosuppressive medications such as azathioprine, methotrexate or cyclophosphamide.
In cases where the mentioned medications failed to achieve the desired effect, doctors may prescribe a more expensive medication known as biologics such as belimumab and rituximab. These are human monoclonal antibodies that work by targeting B-cells from the immune system.