This document provides information about lupus and its treatments. It begins by noting that lupus can affect the body in many ways and medications are used to protect the body from lupus. It then discusses how lupus is an autoimmune disease where the immune system attacks the body. It outlines the common symptoms and organ systems affected by lupus. The document concludes by describing several common medications used to treat lupus, including their purposes, side effects, and monitoring requirements.

1. Onome Whiteru, MD
Fellow, Division of Rheumatology
Albert Einstein College of Medicine
Get into the Loop!
New York City Hospital Tour 2013
Annual Lupus Patient Education Series

2.  You may have wondered:
 “Why am I taking all of these medications in
the first place.”
 You may have felt:
 “I am tired of taking all of these pills”
 You may been concerned about medication
side effects.

3.  Because its your body!
 Lupus can affect your body in so many ways!
 We will talk about the ways lupus can
possibly affect your body.
 Then we will go over the medications for
lupus and how they can help to protect your
body.

4.  Autoimmune disease:
 Caused by an over-active immune system
 Your immune system begins to attack your own
body.
 Certain genes are more likely to occur in patients
with lupus
 Many of these genes involve parts of the immune
system.

5.  Female:Male ratio of 9:1 during childbearing
years
 Closer to 2:1 during childhood and after
menopause, suggesting hormonal influence
 Disease in males can be more severe
 70% of SLE: females between ages 15-45
 10% present age >60

6.  Highest occurrence is in Afro-Caribbean
females 1:250
 African American to Caucasian ratio 3:1
 Child of SLE mother - risk of SLE 7%
 10-15% of SLE patients have 1st degree
relative with SLE

7.  Lupus can be controlled with treatment and in
some instances can go into remission.
 90% survive 5 years, 80% 10 years
 Lupus kidney disease worsens prognosis
 African Americans have more aggressive and
treatment resistant disease
 2 different causes of death:
 Early: disease activity and infections
 Late: due to long-term disease and treatment

8.  Skin
 Brain and Nerves
 Heart
 Lungs
 GI system
 Kidneys
 Joints
 Blood

9.  MALAR RASH:
 Fixed red, flat or
raised, over the bridge of
the nose and cheeks
 Tends to spare the
nasolabial folds
 Discoid lupus:
 Red or dark patches of
inflammation and scarring
 Tends to occur on the
face, ears, and scalp

10.  Ulcers in the
Mouth and Nose:
 Usually painless
 Hair Thinning:

11.  Mood Changes and Psychosis
 Trouble with memory
 Severe unending headache
 Strokes and Seizures
 Vasculitis-inflammation of
blood vessels of the brain
 Neuropathy-tingling, burning
sensation on body
 Myelitis- inflammation of the
spinal cord causing paralysis

12.  Heart:
 Pericarditis- inflammation of the
thin lining around the heart
 Pericardial effusion- fluid build up
around the heart
 Myocarditis- inflammation of the
heart muscle
University of Michigan: www.uofmhealth.org/health
 Lungs:
 Pleuritis- inflammation of the
lining around the lung
 Pleural effusions- fluid build up
around the lung
Cleveland Clinic: www.myclevelandclinic.org

13.  GI System:
 Belly pain, nausea, vomiting,
diarrhea
 Peritonitis-inflammation of the
lining around the abdomen
 Intestinal vasculitis-
inflammation of the blood
vessels with blockage of blood
flow to the intestines
 Joints:
 Found in 80% of patients
 Pain, warmth, swelling and
stiffness of the joints.
 Usually non-erosive
 Can move deformed fingers
back into position

14.  Kidneys:
 Inflammation of the kidneys is
known as nephritis
 A serious complication of lupus
 A leading cause of death in lupus
in the first 10 years of disease
 Patients can notice foamy/bubbly
urine in the commode at home.
 People will usually have no
symptoms of lupus kidney
disease. Your doctor will run tests
on your urine.
 The blood:
 Anemia
 Low white blood cells
 Low platelets
Krames.sjmctx.com

15.  Malar (Butterfly) Rash
 Discoid Rash
 Sensitivity rash to the
sun (Photosensitivity)
 Ulcers in the nose and
mouth
 Arthritis
 Fluid around the
heart, lungs and in
the abdomen
 Lupus kidney disease
 Neurologic Disorders:
 Stroke, inflammation,
depression, memory
dysfunction, etc…
 Anemia, low platelets
and low white blood
cell count
 Abnormal blood
antibody levels
 ANA blood test

16.  Affects of lupus are harmful to your body
 Some complications of lupus are life
threatening
 This is why your medications for lupus are so
important:
 Your medications protect your body from the
harmful and even life threatening affects of
lupus.

17. Active treatment Preventative Treatment
 Topical Steroids
 NSAIDs:
 Advil, Mobic, Naproxen
 Antimalarials:
 Plaquenil
 Steroids:
 Prednisone, Medrol
 Cytotoxics/Biologics:
 Cellcept, Cytoxan, Metho
trexate, Imuran, Benlysta
 Sunscreen
 At least SPF 30
 Calcium, Vitamin
D, Folate supplements
 To help prevent SE from
other medications
 Influenza Vaccine
 Pneumococcal
Vaccine

18.  Typically use both oral and IV steroid in lupus
depending on the severity of manifestation
 Oral:
 Prednisone
 Medrol
 IV:
 Solu-medrol

19.  Very potent anti-inflammatory drugs.
 Not only anti-inflammatory but also suppress
the immune system.
 Work very quickly by blocking the formation
of inflammatory proteins.
 Also promote action of anti-inflammatory
proteins.

20.  Acute Lupus flare
 Active Lupus kidney disease
 Acute active Lupus of the nervous system
 Acute anemias
 Resistent fluid around the heart, lungs or in
the abdomen
 Inflammation of the blood vessels
 Severe fever, fatigue, weight loss, arthritis,
etc.

21.  Increased appetite
 Fluid retention
 Weight gain
 High Blood Pressure
 High cholesterol
 Diabetes
 Stomach ulcers
 Cataracts
 Osteoporosis
 Anxiety/Psychosis

22.  Monitoring:
 Important to follow blood pressure and
cholesterol
 Check bone density for bone loss
 Calcium and vitamin D
 May need alendronate
 Healthy diet to help weight gain and diabetes
 Medicines like omeprazole to help prevent
stomach ulcers
 Frequent eye exams

24.  Also known as Plaquenil
 Old medication used to treat malaria
 Accumulates in the cell interfering with the
recognition of self proteins
 Used as a preventative agent
 Decreases the risk of flare
 Lowers risk of permanent damage
 Also used for joint and skin manifestations

25.  Typically a well tolerated medication
 Safe to use during pregnancy; probably helps
with disease activity
 Side effects include:
 Anemias
 Visual changes
 Retinal problems
 Certain rashes and skin discoloration

26.  Monitoring:
 Most side effects are quite rare
 Recommend frequent eye exams

28.  Other common names: Imuran and Azasan
 Decreases immune cells from proliferating by
stop DNA production in the cells
 Typically used to treat moderate to severe
manifestations of lupus:
 Maintenance of lupus kidney disease
 Anemias including low platelets and blood cell
counts
 Arthritis

29.  Small studies show that the risk for fetal
abnormalities is low when used in pregnancy
 Side effects:
 Anemias
 Infection
 Liver inflammation
 Pancreatitis
 Lymphoma

30.  Monitoring:
 Before starting medication should check for
infections like hepatitis B/C and HIV,
 Requires frequent blood tests to monitor for
anemias, and liver inflammation
 Vaccination to prevent common infections
 Typically do not screen for lymphoma unless
there are concerning symptoms

32.  Other common names: Rheumatrex, Trexall
 Used as a chemotherapy in much higher doses
 Inhibits folic acid metabolism in cells as well as
causes release of adenosine which is anti-
inflammatory
 Typically used to treat the arthritis component
of lupus especially if presenting like rheumatoid
arthritis
 Must take with folic acid to prevent side effects

33.  Methotrexate cannot be taken during
pregnancy and can cause fetal abnormalities
and miscarriage
 Must stop methotrexate and allow for wash
out before getting pregnant
 Side effects:
 Mouth ulcers
 Anemias
 Infections
 Liver inflammation
 Lung fibrosis
 Hair loss

34.  Monitoring:
 Before starting medication should check for
hepatitis, HIV, PPD
 Check baseline chest x-ray
 Frequent blood tests for anemia and liver
inflammation

36.  Other common name: Cellcept
 Mycophenolate mofetil: inhibits a molecule
called inosine monophosphate
dehydrogenase, inhibiting DNA and cell
multiplication
 Typically used for lupus kidney disease as well as
refractory cytopenias, vasculitis

37.  Side effects:
 Nausea/vomiting
 Upset stomach
 Diarrhea
 Anemias
 Infections
 Lymphomas
 Mycophenolate is not safe during pregnancy
and has been proven to cause birth defects
 Patients should be off of this medication
before getting pregnant

38.  Monitoring:
 Frequent blood test to look anemias and any liver
or kidney problems
 Work up any signs of infection
 Aggressive vaccinations to avoid common
infections

40.  Other common name: Cytoxan
 Cyclophosphamide works by causing changes
to DNA so that inflammatory cells cannot
multiply
 Typically used for the most severe
manifestations of Lupus:
 Lupus kidney disease
 Lupus of the nervous system
 Severe vasculitis
 Severe refractory anemias

41.  Cyclophosphamide can be given either IV or
orally but is a chemotherapeutic agent
 Side effects:
 Nausea/Vomiting
 Hair loss
 Anemias
 Infections
 Inflammation of the bladder
 Infertility
 Cyclophosphamide is not safe during pregnancy.
Can cause birth defects and fetal loss.
 Must be off medication before getting pregnant

42.  Monitoring:
 Aggressive hydration and the medication MESNA
to help prevent bladder issues
 Anti-nausea medication
 Frequent blood tests especially to monitor for
anemias
 Lupron monthly to help limit infertility
 Immunizations

44.  Other common name: Benlysta
 Is given as monthly IV infusions
 In an antibody that inhibits the molecule
BAFF
 BAFF stimulates B cell production: the cells that
churn out auto-antibodies in lupus that can cause
damage
 Used to:
 Help get patients off of their steroids
 Particularly effective for the skin and arthritis
manifestations of lupus

45.  Side effects:
 Infection
 Allergy
 Infusion reaction
 It is unknown what the risk to the fetus is
during pregnancy
 Monitoring:
 Frequent labs
 Vaccines and avoidance of infection

46.  Irene Blanco, MD
 Yasmin Santiago
 Our Audience!