LUPUS: A Guide for Nurses
Lupus is usually treated with drugs and these can be divided into four main groups, depending on the severity of the disease.
Anti-inflammatory drugs (NSAIDS), used for patients who suffer mainly from joint, muscle pain. In the case of patients with "sticky blood" ASPIRIN in low dosage 75/150mg daily is used to thin the blood.
These are of help in patients with skin and joint involvement. These drugs may be sufficient for patients with moderately active lupus to avoid using steroids. Hydroxychloroquine and mepacrine are most commonly used.
Steriods such as prednisolone have been vital in the improvement in lupus care and in some cases are life saving. They have a profound effect on inflammation and suppress active disease. The dosage depends on the severity of the disease. Once the disease is under control the patient can be weaned off gradually.
These drugs are widely used in more severe disease. The most commonly used are azathioprine, methotrexate and cyclophosphamide. Regular blood testing is required initially 2-3 weekly, subsequently 4-6 weekly whilst on this medication as these drugs also suppress the blood forming cells in the bone marrow, and can affect the liver in the case of methotrexate and azathioprine.
In more aggressive lupus IV cyclophosphamide is administered over a period of months. Other agents sometimes used include IV Immunoglobulin therapy for treatment of thrombocytopenia. Thalidomide has also been used orally in some cases of aggressive skin disease. Iloprost infusions may be given for Raynauds where circulation is severely diminished in the hands and feet. Methyl prednisolone infusions can be of benefit to patients with severe joint involvement.