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Pain
and Treatment
Can I alleviate the pain when the medications do not seem to work and the
doctor cannot see me in a few days?
If
you can find relief from the heat, while others find relief from the cold.
And others find relief by a distraction to decrease the awareness of
pain which may be very beneficial.
TREATMENT
Currently
at the present there is no cure for lupus, there is however effective
treatment for the symptoms.
34.
How is lupus treated?
Inflammation
is the main cause of the symptoms of lupus, so the treatments are designed to
reduce the inflammation. Several
medications are used to correct the inflammation and there are four medical
families that are used for lupus treatment.
Nonsteriodal anti-inflammatory drugs, Corticosteriods, Anti-malarials which
are effective with joint pain, skin rashes, and ulcers. Immunosuppresents is the fourth family of medications which
are used.
The
first three families of medications are used for the treatment of lupus for
the majority of people. The are
used either alone or in combination, individuals respond differently to
medications and time is necessary to determine which medication will work best
to provide relief to the individual.
Is
predinsone my only option for lupus treatment?
Sometimes
lupus is best treated with steroids and is the best choice of therapy while
the other medications are ineffective.
Can
I eliminate the weight gain brought about by prednisone?
Increased
appetite is well recognized as a side effect of corticosteroid therapy. Often
times, just being aware that this increase in appetite may occur with the
steroid therapy, is the first step towards managing the potential weight gain.
If you have to go on steroids or if you have to increase your dosage of
steroids, you may want to consider planning out a healthy diet during the time
you're taking steroids and making sure that you stick to it. During those
times, however, when you're really hungry, here are some things you can do to
combat the munchies:
One
of the main side affects of using steroids is weight gain during therapy.
Just being aware sometimes allows you to monitor your increased
appetite during the therapy. Realizing
that this is one side affect you may be able to manage your potential weight
gain. Planning in advance for a
good educated diet helps before going on the steroidal therapy.
Try to combat the munchies with healthy choices instead of sugary
snacks. Some ideas to try is to
drink a lot of water which might help you feel full, and try low sodium juice.
Low fat popcorn, raw veggies, try exercising go for a walk.
There
are several substitutions you can make that are healthy which will reduce your
overall caloric intake which will curb your appetite.
Try reducing your sodium intake so you will not retain so much fluid.
This can be accomplished by cooking your meals instead of boxed food,
frozen or refined and processed foods. Read
the labels carefully and try to make the right choices for your health.
You may contact support groups that specialize in weight gain and
weight control efforts.
Do
you recommend any herbs or vitamins for the treatment of lupus?
Herbs
or vitamins are not recommended specifically for lupus.
However you may research several herbal remedies that might work for
those suffering from lupus, just be very careful just because it is herbal you
need to make the right choices for your body.
A
single multi vitamin daily should be most adequate for your diet.
Where
is the BEST place to go for diagnosis and treatment of lupus?
The
lupus foundation of America does not have a mechanism by which it can rate a
specific hospital or physician. The
general recommendation is find a physician that is affiliated with a medical
school which has several staff members that could be doing a lupus research
study and they would be most up to date with the latest advances in diagnosis
of lupus treatment. They are good
places to go for diagnosis and treatment of lupus.
Treatment
Treatment
for Lupus erythematosus is a chronic disease and treatment is restricted
dealing with the symptoms because it is a chronic disease with no known cure.
You would like to prevent the flares and reduce the severity of the
duration of them. They can be
treated with medications, alternative medicine, and lifestyle changes.
Sept.
14, 2006 -- An exciting new study shows a new target for future lupus
treatments.
Lupus
is an autoimmune disease: The body is attacked by its own immune system. In
lupus, that attack may come from a kind of immune cell called a B cell.
As
the body makes new B cells, a few of them go haywire and try to attack the
body. Normally, the body quickly eliminates these cells. But in lupus, they
somehow survive.
A
special hormone called B-cell-activating factor -- or BAFF -- helps these
self-attacking B cells survive. And people with lupus and some other
autoimmune diseases overproduce BAFF. Eventually, these B cells build up to
dangerous levels and cause lupus.
Hiding
in the Spleen
Now
a research team, including Michael Karin, PhD, of the University of
California, San Diego, finds that B cells build up in a specific part of the
spleen called the marginal zone. Mouse studies suggest that if the B cells
can't hide in the spleen, they can't cause lupus. What lets
lupus-causing B cells lurk in the spleen is a chain of chemical signals called
the NF-kB pathway. You need a functional NF-kB pathway for your immune system
to fight infections. But this pathway is made up of two parts: the classical
NF-kB pathway and the alternative NF-kB pathway.
In
mouse experiments, Karin's team now finds that partial disruption of just the
alternative NF-kB pathway is enough to keep lupus-causing B cells from hiding
in the spleen.
"Our
findings suggest that incomplete inhibition of the alternative NF-kB pathway
… may be a sufficient therapeutic option for patients suffering from
autoimmune disease associated with BAFF overproduction," the researchers
suggest. "Inhibition of the alternative NF-kB pathway is less likely to
cause an immune deficiency, which is commonly seen after blockade of the
classical NF-kB pathway."
SOURCE:
Enzler, T. Immunity, September 2006, VOL25
Drug
therapy
Lupus
patients have a variety of symptoms and organ involvement that the severity of
SLE in a particular patient must be assessed to successfully treat SLE.
Remittent and mild diseases can sometimes be safely left untreated.
Severe
cases of SLE require medications that modulate the immune system which are
used to control the disease and prevent re-occurrence of symptoms.
Flares are reduced by disease modifying antirhematic drugs which lower
the need for steroid use. When
the flares occur they are treated with Corticosteriods. Antimalarial drugs are used for cutaneous and articular
manifestations, while cyclophosphamides are used in severe organ damaging
complications.
With
steroid use patients may develop obesity, diabetes and osteoporosis usually
depending on the dosage. Corticosteriods
can cause puffy face, large appetites and diffuculty sleeping.
The side effects can subside when the large doses are reduced, but long
term use of low doses of medications can elevate blood pressure and cataracts.
Due to the following side effects steroids are avoided if possible.
Acupuncture
Lupus
and Acupuncture study done in 1985 reported an improvement in lupus sufferers
which over matched controls, even there was no placebo group comparison with
that finding. It is possible that
acupuncture may be useful with the treatment of lupus symptoms.
Lifestyle
changes
Avoiding
sunlight and covering up with sun protection clothing can be very useful and
effective in treating problems due to photosensitivity.
Weight loss is recommended when you are overweight or with obese
patients, alleviating some of the side effects of the disease is helpful when
joint involvement is present.
Treatment
Research
Under
investigation is immunosuppresents and autologus stem cell transplants are a
possible cure. Gaining attention
are stem cell research and proteins that secrete cytokine proteins are being
recognized.
Prevention
Lupus
is not understood well enough to be prevented, but when the disease develops,
quality of life can be improved through flare prevention. The warning signs of
an impending flare include increased fatigue, pain, rash, fever, abdominal
discomfort, headache and dizziness. Early recognition of warning signs and
good communication with a doctor can help individuals with lupus remain
active, experience less pain and reduce medical visits.[2]
Prevention of complications
during pregnancy
Infants
that are born to mothers who have lupus are mostly healthy,
pregnant mothers with SLE should remain under a doctors care until
delivery. Identification of
mothers with neonatal lupus are at highest risk for complications.
SLE can flare during and after pregnancy but with proper treatment can
maintain the health of the mother for longer.
Women pregnant with the known antibodies (SSA) and (SSB) should have a
echocardiogram during the 16th and 30th weeks for
pregnancy to monitor the health of the heart and surrounding vasculature.
Prognosis
SLE
patients lived fewer than five years in the 1950’s, which has lead to
advances in diagnosis and treatment have improved survival to the point of
over 90% of the patients live more than ten years and many can live
asymptomatically. The most common
cause of death is due to infection with immunosuppression medications used to
manage the disease. Men have a
worse prognosis then women. If
you develop symptoms after the age 60 the disease tends to run a more benign
course.
Good news ...for Lupus suffers there's been a treatment Breakthrough
From the University of Vienna, Vienna, Austria;
PURPOSE: Tumor necrosis factor (TNF) is significantly increased in the
sera of patients with systemic lupus erythematosus (SLE) and in the
kidney biopsies of patients with lupus glomerulonephritis, and
associated with systemic and nephritic disease activity, respectively.
We therefore decided to evaluate the safety and efficacy of TNF
blockade on inflammatory manifestations of SLE in a pilot trial of
infliximab in SLE.
PATIENTS AND METHODS: Within an open safety study approved by the
ethics committee of Vienna University Medical School, SLE patients
with nephritis and/or arthritis are being treated with the humanized
chimeric anti-TNF antibody infliximab and with azathioprine or
methotrexate plus low dose corticosteroids. Patients are closely
monitored for proteinuria, swollen and tender joint counts, clinical
disease activity and infections, as well as for autoantibodies to
dsDNA and serum complement levels. So far, infliximab treatment was
initiated in 6 SLE patients (3 with nephritis, 1 with nephritis and
arthritis, and 2 with arthritis only).
RESULTS: In all lupus nephritis patients treated with Infliximab,
proteinuria fell significantly under TNF-blocking therapy (from
4.1±2.4 g/24h at the onset of therapy to 0.9±0.4 g/24h at the time of
the last infusion). In the first two patients, where infliximab
therapy was completed at least six months ago, proteinuria stayed low
through week 36 (at 1.37 (from 5.72) g/24h and 0.42 (from 1.19) g/24h,
respectively). The (normal) creatinine serum levels remained stable in
all patients. Severe non-erosive lupus arthritis in two patients and
rheumatoid factor negative erosive lupus arthritis in another one
remitted within days after the onset of therapy. However, in the first
arthritis patient treated, arthritis relapsed 8 weeks after the last
infliximab infusion and follow up of the other two patients has not
yet passed this point. In two patients, autoantibodies to
double-stranded DNA increased under therapy but without concomitant
flare and with a tendency to decrease again after the last infusion of
infliximab; serum complement remained unchanged in all patients. One
patient had a febrile episode with consecutive thrombocytopenia of
presumably viral origin after the second infliximab infusion, which
did not recur under the following two infusions. Two patients suffered
from uncomplicated urinary tract infections and were treated with oral
antibiotics.
CONCLUSIONS: Our data on six SLE patients treated with anti-TNF
therapy, in combination with azathioprine or methotrexate and low dose
corticosteroids, suggest that this treatment modality is feasible in
SLE patients and apparently improves lupus nephritis. Infliximab also
induces a remission of lupus arthritis, which may be transient after
therapy is stopped. Controlled trials of TNF blockade in SLE are
warranted.
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