What are the best treatments for lupus
How is systemic lupus erythematosus treated?
SLE is a chronic disease, the treatment concept of which depends on which organs are affected and how severe or mild the disease is (so-called disease activity). There are numerous treatment options available for this.
Different preparations are used depending on the affected organ system and disease activity. The disease activity is determined by the treating rheumatologist with the help of different indices (e.g. European Consensus Lupus Activity Measurement = ECLAM or Systemic Lupus Erythematosus Disease Activity Index = SLEDAI).
Anti-malaria drugs (chloroquine, hydroxychloroquine) are the basic medication for SLE and should always be administered. B. pathological changes in the cornea or retina of the eyes or allergic reactions assumed. In addition to a positive influence on disease activity and the course of the disease, anti-malaria agents have a good effect on joints and skin and have a protective effect on the kidneys. Furthermore, anti-malaria therapy improves the cardiovascular risk profile. For example, the increased risk of heart attack associated with SLE is reduced.
Mild to moderate disease activity
For joint pain (arthralgia) and joint inflammation (arthritis), NSAIDs (e.g. ibuprofen, diclofenac, etc.), intra-articular and systemic steroids, methotrexate, leflunomide or belimumab are used. If the focus is on skin involvement, local preparations (steroids, tacrolimus), systemic steroids, methotrexate, azathioprine or belimumab are administered. Systemic steroids, azathioprine, methotrexate or belimumab are used for inflammation of the lungs or pericardium (general serositis), systemic steroids or azathioprine for an attack on the blood-forming system.
High to very high disease activity
Systemic steroids, cyclophosphamide or rituximab are used if there is a risk of loss of an organ function (lupus nephritis), involvement of the nervous system or danger to life. Depending on the severity of the lupus nephritis, mycophenolate mofetil, cyclosporine or azathioprine can alternatively be given at the beginning or later. In addition, a so-called angiotensin converting enzyme inhibitor (ACE inhibitor) or angiotensin1 receptor blocker (AT1 blocker = sartan) is always administered in lupus nephritis. If the course of lupus nephritis cannot be controlled, kidney replacement procedures such as B. dialysis or a kidney transplant is necessary. The administration of intravenous immunoglobulins, plasma exchange (plasmapheresis) or stem cell transplantation are reserved for severe cases that cannot be treated with the usual treatment options.
SLE patients with proven antiphospholipid antibodies but lacking clinical symptoms are treated prophylactically with low-dose acetylsalicylic acid (100 mg daily). If there is also an embolism, thrombosis or premature birth or miscarriage, the blood must be diluted more intensively with phenprocoumon or comparable drugs.
General measures by the patient and the attending physicians
- Regular check-ups by the family doctor and rheumatologist to assess disease activity, monitor therapy and optimize cardiovascular risk factors (blood pressure, blood lipids, blood sugar, etc.)
- If necessary, psychosomatic or psychotherapeutic support
- Exchange with other affected persons (self-help groups)
- Avoidance of overweight (obesity)
- Balanced diet (Mediterranean diet)
- Sufficient calcium and vitamin D intake to prevent osteoporosis
- Alcohol only in moderation
- Refrain from nicotine
- Sufficient sun protection (appropriate clothing, sun protection cream with a sun protection factor of at least 30)
- Regular, aerobic endurance sport (e.g. three times a week for 30 minutes each)
- If necessary, occupational or physiotherapeutic measures
- If necessary, avoidance of preparations containing estrogen (especially oral contraception = pill)
According to the recommendations of the Standing Vaccination Commission (STIKO), vaccinations are particularly important for patients with inflammatory rheumatic systemic diseases, such as SLE, in order to reduce the increased risk of infection due to the disease. The only restrictions are the use of live vaccines (vaccination against measles, mumps, rubella, etc.). These are contraindicated in those SLE patients receiving immunomodulatory therapy. This does not apply to SLE patients who take cortisone with a prednisone equivalent of less than 20 mg daily or anti-malarial agents (chloroquine, hydroxychloroquine). In contrast, dead vaccines (vaccination against tetanus, diphtheria, pertussis, polio, human papillomavirus, pneumococci, influenza, hepatitis, TBE, zoster, etc.) do not pose a problem bring up to date.
Treatment in special situations
In the case of long-distance travel, infections, upcoming operations or an (un) planned pregnancy, SLE patients should always contact their treating rheumatologist if possible, as the therapy may have to be adjusted accordingly.
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