The treatment of SLE is as varied as its course. Although there is no cure for lupus and it is difficult to predict which treatment will be most effective for each patient, there have been significant gains in treating patients, and there is general consensus on several treatments.
A conservative regimen of physical and emotional rest, protection from direct sunlight, a healthful diet, prompt treatment of infections, and avoidance of known allergens and aggravating factors are the mainstays of lupus therapy. In addition, for female patients, pregnancy must be planned for times when the disease is in remission.
This basic component of everyone’s good health is essential for the lupus patient. The fatigue of lupus is not sleepiness or tiredness from physical exertion, but rather a frequent, persistent complaint often described as a “bone-tired feeling” or a “paralyzing fatigue.” Normal rest often does not refresh the patient or eliminate the tiredness due to lupus, and fatigue may persist despite normal laboratory test results. The patient and family need instruction on how to use this tiredness as a guide to activity and when the person should stop for rest. It must be reinforced that this need for rest is not laziness. Restful sleep of 8–10 hours per night, naps, and “timeouts” during the day are basic guidelines; strict bed rest is usually not required. Physical activity should be encouraged as the patient can tolerate it. An individualized exercise routine may facilitate recovery from a flare and promote well-being.
A patient’s emotional stressors should be carefully assessed, because they may play a role in triggering a flare. The patient should be instructed on how to avoid these stressful situations. However, the physical manifestations of lupus must be treated as they present themselves while the emotional stresses are explored. Discussions with the family on this issue are essential for providing information and in obtaining their support. Counseling for both the patient and the family may be an option.
Protection From Direct Sunlight
Photosensitivity is an abnormal reaction to the ultraviolet (UV) rays of the sun and results in the development or exacerbation of a rash that is sometimes accompanied by systemic symptoms. About one-third of lupus patients are photosensitive. All lupus patients should avoid direct, prolonged exposure to the sun. Sun-sensitive patients should frequently apply a sunscreen with a Sun Protection Factor (SPF) of at least 15, avoid unprotected exposure between 10 a.m. and 4 p.m., and wear protective clothing, such as wide-brimmed hats and long sleeves. Lupus patients should be aware that UV rays are reflected off water and snow, and that glass, such as car windows, does not provide total protection from UV rays.
Lupus patients should also know that fluorescent and halogen lights may emit UV rays and can aggravate lupus. This may be an issue for patients who work in offices lit by these kinds of lights. Sunscreen and protective clothing can help minimize exposure, and plastic devices are available that block UV emissions from fluorescent or halogen light bulbs.
Diet and Nutrition
A well-balanced diet is essential in maintaining good health for all people, including lupus patients. There are currently no specific dietary recommendations or limitations for those with lupus, but a restricted diet plan may be prescribed when fluid retention, hypertension, kidney disease, or other problems are present. Food intolerances and allergies may occur, but there is no evidence that these are more common in lupus patients than in the general population. The health professional should make a note of the patient’s dietary history and suggest diet counseling if appropriate, especially if the patient has a problem with weight gain, weight loss, gastrointestinal (GI) distress, or food intolerances.
Treatment of Infections
Prompt recognition and treatment of infection is essential for those with lupus. However, cardinal signs of infection may be masked because of SLE treatments. For example, a fever may be suppressed because anti-inflammatory therapy is being given. When an infection is being treated, the health professional should be alert to medication reactions, especially to antibiotics.
Pregnancy and Contraception
Spontaneous abortion and premature delivery are more common for women with SLE than for healthy women. To minimize risks to both mother and baby, a pregnant woman with lupus should be closely supervised by an obstetrician familiar with lupus. The safety of oral contraceptives for women with lupus is currently under investigation. The use of an intrauterine device (IUD) is not recommended because of the lupus patient’s increased risk of infection.
Surgery may exacerbate the symptoms of SLE. Hospitalization may be required for otherwise minor procedures, and postoperative discharge may be delayed. If it is elective, the surgery (including dental surgery and tooth extraction) should be postponed until lupus activity subsides.
Immunizations with killed vaccines have not been shown to exacerbate SLE. However, live vaccines with attenuated organisms are not advisable. A lupus patient should consult her or his doctor before receiving any immunizations, even routine ones.
Medications for SLE
SLE management should include as few medications for as short a time as possible. Some patients never require medications, and others take them only as needed or for short intervals, but many require constant therapy with variable doses. Despite their usefulness, no drugs are without risks. Medications frequently used to control the symptoms are nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarials, corticosteroids, and immunosuppressives. Other medications may be necessary to control specific manifestations. Before prescribing a medication, it is helpful to scrutinize a patient’s past response to treatments. A careful drug history should be taken; in particular, hypersensitivities or allergies to certain drugs should be noted, as these may aggravate the lupus. Patient and family education about medications and their side effects is essential.
Source: National Institutes of Health
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