What you Need to Know About Lupus

Lupus Awareness Month

What is lupus?

Lupus is a chronic inflammatory disease in which the body attacks its own healthy cells (often referred to as an autoimmune disorder).  The immune system produces antibodies that can damage cells in the skin, joints and other organs of the body.  Lupus is a disease that can go through cycles of having and not having signs and symptoms of the disease, often referred to as disease flares (symptoms) and disease remission (no symptoms).  The main focus of this UIC Pharmacy blog will be on the most common type of lupus, called systemic lupus erythematosus or SLE.

Are there different types of lupus?

There for 4 types of lupus:

·      Systemic Lupus Erythematosus (SLE)

o   The most common type of lupus

o   Usually referred to only as “lupus”

o   Most commonly occurs in women

o   Signs and symptoms can range from mild to severe

·      Drug-induced Lupus Erythematosus

o   Caused by certain prescription medications (see discussion below)

o   Symptoms mimic the signs and symptoms of SLE

o   More common in men than women

·      Cutaneous Lupus Erythematosus

o   Symptoms only involve the skin and can include rash, skin lesions, hair loss, or changes in skin pigment or color

o   Areas of the skin exposed to sunlight (such as the face, neck and scalp) are most commonly affected

o   Most common types of rashes are known as discoid rash (a red, disc-like rash)  and butterfly rash (a rash over the cheeks and bridge of the nose)

o   Approximately 10% of people with this type of lupus will develop SLE

o   For more information visit http://www.americanskin.org/resource/lupus.php

·      Neonatal Lupus

o   Is rare and occurs in 1% to 2% of infants whose mothers have lupus

o   It can present in infants as a skin rash, problems with the liver, or heart problems

o   Symptoms usually disappear within several months of age with no other problems

o   For more information visit www.lupus.org

Systemic Lupus Erythematosus

How many people have SLE?

·      There are approximately 20 to 70 cases of SLE per 100,000 people worldwide

·      Most commonly occurs in women 20 to 45 years old

·      African Americans and those of Asian descent are 2 to 3 times more likely to have SLE than whites

What are the signs and symptoms of SLE?

Signs and symptoms vary from person to person and often more will appear as the disease progresses.  These can present in the muscle, bones, skin, blood, brain, heart, kidneys, gastrointestinal tract, and eyes.  Below are some of the more common signs and symptoms that can be seen with SLE.

·      Fatigue and general discomfort

·      Fever

·      Loss of appetite or weight loss

·      Muscle pain/weakness

·      Joint pain (arthritis)

·      Sensitivity to sunlight

·      Anemia (low red blood cell count)

·      Leukopenia (low white blood cell count)

·      Rash on the cheeks and nose (butterfly rash)

·      Sores in the mouth

·      Hair loss

·      Thought or mood disorders

·      Inflammation of the lining around the lungs and heart

·      Kidney disorders

·      Nausea and diarrhea

·      Mild gastrointestinal pain

·      Headaches

What are the causes of SLE?

The actual cause of SLE is unknown.  However, several possible causes or “triggers” have been suggested.

·      Genetics (a family history of lupus or other autoimmune disorders)

·      Exposure to sunlight

·      Exposure to certain drugs or chemicals

·      Diet

·      Infections (both viral and bacterial)

·      Hormones (such as estrogen)

·      Stress to the body (physical or emotional)

How is SLE diagnosed?

There is no single test available to diagnosis lupus.  Usually, lupus is diagnosed based on signs and symptoms present, as well as changes or unusual findings in laboratory tests.  Other methods to help diagnose lupus include a physical examination, medical history, a chest x-ray, and a urine or blood analysis.  One very specific blood test that is done is called the Antinuclear Antibody (ANA) test.  This test looks for the presence of the antibodies produced by the immune system, which are attacking the body.

How do you treat lupus?

Treatment of SLE is initially to manage current symptoms (disease flares) and stop these signs and symptoms from recurring (to induce a disease remission).  Once the initial symptoms have been controlled, the goal is then to extend the time before the next disease flare.  Treatments can vary from one individual to another based on how the disease is presenting.  Below is a list of  lifestyle and drug approaches used for treatment.

·      Lifestyle changes

o   Get plenty of rest and exercise

o   Eat a balanced diet

o   Avoid overexertion

o   Avoiding tobacco smoke/smoking

o   Use sunscreen or limit sun exposure

·      Drug therapy

o   Analgesics (examples: nonsteroidal anti-inflammatory drugs [ibuprofen or naproxen], salicylates [low-dose aspirin]) 

§  Used in mild disease

§  Useful for treatment of fever, arthritis, and lung/heart inflammation

o   Antimalarial (examples: chloroquine, hydroxychloroquine)

§  Used in mild disease for long-term symptom management

§  Useful for skin involvement, joint pain, fatigue, and fever

o   Corticosteroids (examples: prednisone, methylprednisolone)

§  Use ranges from mild to life-threatening disease

§  Useful when the previous 2 classes of drugs have not worked or when the symptoms are serious

o   Immunosuppressive medications (examples: cyclophosphamide, azathioprine, mycophenolate)

§  Used in severe disease

§  Useful when organs such as kidneys or brain are threatened.

Sometimes patients do not respond to medications that are usually used for the treatment of lupus or have severe lupus that does not respond to standard medications.  In this case, other medications can be tried. Most of these medications are still being studied to see what their role is in the treatment of lupus, but some patients are willing try these not knowing if they may  benefit from treatment.  Many of these other medications act on the immune system to prevent damage to the cells of the body by its own antibodies. 

·      Examples: abatacept, belimumab, cyclosporine, dehydroepiandrosterone (DHEA), eculizumab, efalizumab, epratuzumab, infliximab, rituximab, sirolimus, and tacrolimus.

·      More information can be found at: http://www.lupusresearchinstitute.org

Drug-induced lupus

Drug-induced lupus is treated differently than SLE.  Symptoms usually disappear once the offending drug has been stopped, but it can take up to 6 months before these symptoms are completely gone.  The table below lists some drugs that have been associated with drug-induced lupus.

Definitely	Possibly	Suggested	Reported
Chlorpromazine	Anticonvulsants a	Calcium channel blockers	Bupropion
Hydralazine	Antithyroid drugs b	Captopril	Clobazam
Isoniazide	Beta-blockers c	Ciprofloxacin	Clozapine
Methyldopa	Fluorouracil agents d	Clonidine	Etanercept
Minocycline	Hydrochlorothiazide	Estrogens and oral contraceptives	Infliximab
Procainamide	Interferon α (IFNα)	Gemfibrozil	Interleukin-2
Quinidine	Penicillamine	Gold Salts	Lisinopril
	Statins e	Griseofulvin	Tocainide
	Sulfasalazine	Hydroxyurea	Zafirlukast
	Terbinafine	Interferons (other than IFNα)
		Lithium
		Para-aminocalicylic acid
		Penicillin
		Phenylbutazone
		Reserpine
		Rifampicin
		Streptomycin
		Tetracycline

^a Anticonvulsants: carbamazepine, ethosuximide, phenytoin, primidone, trimethadione, valproate, zonisamide.

^b Antithyroid drugs: propylthiouracil, methimazole, thiamazole.

^c Beta-blockers: acebutolol, labetalol, propranolol, pindolol, atenolol, metoprolol, timolol.

^d Fluorouracil agents: fluorouracil, tegafur.

^e Statins: lovastatin, simvastatin, fluvastatin.

Where can I get more information about lupus?

There are a number of professional organizations that provide information on the different types of lupus, associated symptoms, and treatment options.  You can also always ask your pharmacist for more information on lupus and its treatment.

The Lupus Foundation of America

·      http://www.lupus.org/

The Arthritis Foundation

·      http://www.arthritis.org/

Lupus Research Institute

·      http://www.lupusresearchinstitute.org/

Prepared by: Rebecca Zeilder, PharmD candidate

University of Illinois at Chicago

May 2012