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Systemic Lupus Erythematosus (SLE): New Treatments for Mild and Severe
Dr. Peeva is an Instructor of Medicine and Attending Physician at the Albert Einstein College of Medicine and Attending Physician at Montefiore Medical Center, NY, and Dr. Zandman-Goddard is an Instructor of Medicine and Attending Physician at Sheba Medical Center, Israel.
Mild SLE
Not long ago, systemic lupus erythematosus (SLE) was thought to be fatal in nearly all cases. Few SLE patients lived much longer than five years after being diagnosed. In recent decades, thankfully, the outlook for those with SLE has brightened. According to the latest figures, more than 80% of those diagnosed with SLE will survive more than ten years and many will enjoy a normal life span.
We have made dramatic progress against SLE because potent new antibiotics are available to combat and prevent the serious and unusual infections that may complicate SLE. In addition, more effective corticocosteroids and immunosuppressive drugs now enable treatments for the various kinds of organ damage that SLE can cause. A good example is end stage renal disease, a potentially fatal kidney condition, which can be managed with improved dialysis and kidney transplant techniques. Finally, better diagnostic tests are helping doctors detect SLE earlier and identify milder forms of SLE that in the past would have been missed.
Many mild SLE sufferers are young women whose symptoms are limited to arthritis-like joint pain, episodes of fatigue, sunlight-induced skin rashes, mild anemia and problems with blood platelet regulation. Mild SLE sufferers never develop the life-threatening severe form of the disease. That is the good news. The bad news is that for those with mild SLE, the side effects of conventional treatments, such as long term corticosteroid and immunosuppressive drugs, outweigh their benefits. In this article, we will look at some of the current treatment choices for those with mild SLE, with particular attention to ground-breaking, new treatments that involve manipulating the body's own hormones.
General Treatments and Precautions
While only a minority of those with mild SLE develop photosensitivity (problems tolerating sunlight), it is still a good idea for anyone with SLE to avoid excessive exposure to the sun. It is also makes good sense to use sunscreens with an SPF of at least 25. For women practicing birth control, oral contraceptives should be avoided because studies have shown that the estrogen they contain can cause SLE to flare up. These studies have not found any problem with the lower doses of estrogen used in hormone replacement therapy for menopausal women, but researchers are continuing to investigate this question.
Some people with SLE have a tendency to form blood clots. While doctors have a good test for identifying those at the greatest risk, most doctors recommend that SLE sufferers take a daily low dose aspirin, which acts as a mild blood thinner.
Another common problem associated with SLE is hypertension (high blood pressure). If you have SLE, it's especially important to control hypertension so as to avoid serious damage to kidneys and arteries. All of the standard drugs for high blood pressure have been used in patients with SLE and they seem to be equally effective and safe. An exception is sulfonamide drugs, which can cause allergic reactions in SLE sufferers and should be avoided or used with caution.
NOTE: We regret that we cannot answer personal medical questions.
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