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Lupus treatment includes care for symptoms as they arise, plus treatments aimed at slowing down the overall course of the disease, such as anti-inflammatories, steroids, and immunosuppressants. Every lupus patient should also have their Vitamin D status regularly monitored, and optimized. (Also see Autoimmune Diseases and Overview of Lupus)
Lupus Treatment Currently, there is no cure for lupus. But treatments can ease symptoms and reduce complications. Mayo Clinic
Early–stage predictors for treatment responses in patients with active lupus nephritis (LN). The change percentage of urinary protein-to-creatinine ratio >59% and the serum albumin >32.9g/l at the third month were valuable for predicting remission at the sixth month in LN. PubMed, Lupus. 2019 Mar;28(3):283-289.
Comparative Rates of Serious Infections Among Patients With Systemic Lupus Erythematosus (SLE) Receiving Immunosuppressive Medications. In a nationwide longitudinal study of Medicaid SLE patients at high risk of infection, rates of serious infection and mortality did not differ among new users of mycophenolate mofetil, azathioprine, or cyclophosphamide. PubMed, Arthritis Rheumatol, 2017 Feb;69(2):387-397.
Risk of high–grade cervical dysplasia and cervical cancer in women with systemic lupus erythematosus (SLE) receiving immunosuppressive drugs. Among women with SLE, immunosuppressive drugs may be associated with a greater, albeit not statistically significant, risk of high–grade cervical dysplasia and cervical cancer compared to patients receiving hydroxychloroquine alone. PubMed, Lupus, 10/31/2016. (Also see Immunosuppressants and Cancer)
How is systemic lupus treated? There is no permanent cure for systemic lupus. The goal of treatment is to relieve symptoms and protect organs by decreasing inflammation and/or the level of autoimmune activity in the body. Many patients with mild symptoms may need no treatment or only intermittent courses of antiinflammatory medications. MedicineNet
Does Renin‐Angiotensin System Blockade Protect Lupus Nephritis Patients From Atherosclerotic Cardiovascular Events? A Case–Control Study. Our data do not support the hypothesis that ACE inhibitors/ARBs may be protective against atherosclerotic CVEs in lupus nephritis patients. Wiley, 11 February 2016.
Supervised physical exercise improves endothelial function in patients with systemic lupus erythematosus. Physical exercise is a useful strategy to improve endothelial function and aerobic capacity without worsening disease activity in SLE patients. Rheumatology.
HIBISCUS: Hydroxychloroquine for the secondary prevention of thrombotic and obstetrical events in primary antiphospholipid syndrome. Hydroxychloroquine (HCQ) appears as an additional therapy, as it possesses immunomodulatory and anti-thrombotic various effects. PubMed, Autoimmun Rev, 2018 Dec;17(12):1153-1168. (Also see Antiphospholipid and Antimalarials)
Anti-Malarials in the Treatment of Lupus. Anti-malarials are particularly effective in treating skin and joint symptoms that may occur in SLE. They have been demonstrated to improve muscle and joint pain; inflammation of the lining of the heart (pericarditis); inflammation of the lining of the lung (pleuritis); and other symptoms of lupus such as fatigue and fever. Lupus Foundation of America.
Mycophenolate mofetil (MMF) reduces STAT3 phosphorylation in systemic lupus erythematosus (SLE) patients. The inhibition of STAT3 phosphorylation by MMF may explain the effectiveness of this treatment in SLE patients, since increased levels of p-STAT3 are associated with disease pathology. PubMed, JCI Insight, 2019 Jan 24;4(2).
Effect of corticosteroids and cyclophosphamide on sex hormone profiles in male patients with Systemic Lupus Erythematosus (SLE) and Systemic Sclerosis (SSc). Our study highlights the negative impact of corticosteroids on the gonadal function in male SLE and the use of cyclophosphamide during the year prior to inclusion impaired bioactive testosterone levels in SLE and SSc. PubMed, Arthritis Rheumatol, 01/31/2017.
Diet and Nutrition. In general, you should try to eat a nutritious, well-balanced, and varied diet that contains plenty of fresh fruits and vegetables, whole grains, moderate amounts of meats, poultry, and oily fish, as fish oil has been found to help reduce inflammation. Lupus Foundation.
Methotrexate (MTX) in systemic lupus erythematosus (SLE). The use of MTX is associated with significant reductions in SLE Disease Activity Index and the average dose of corticosteroids in adult patients with SLE. PubMed, Lupus. (Also see Methotrexate)
Possible evidence of systemic lupus erythematosus (SLE) and periodontal disease association mediated by Toll–like receptors 2 and 4. Periodontal treatment is able to reduce the expression of these Toll–like receptors 2 and 4 and therefore the symptoms of SLE. PubMed, Clin Exp Rheumatol, 2016 Feb;183(2):187-92.
It hasn't gone away: the problem of glucocorticoid use in lupus (SLE) remains. We review the evidence for the harmful effects of glucocorticoids in SLE, and propose therapeutic options that reduce reliance on glucocorticoids. PubMed, Rheumatology (Oxford), 2017 Apr 1;56(suppl_1):i114-i122. (Also see Glucocorticoids, Steroids (Prednisone) Warnings)
Lupus nephritis and B–cell targeting therapy. The combination of different targeted approaches as well as a focus on new clinical end–points may be strategies to identify new therapeutic options. PubMed, Expert Rev Clin Immunol, 08/11/2017. (Also see B Cells and T Cells)
Predicting and managing primary and secondary non-response to rituximab using B-cell biomarkers in systemic lupus erythematosus. Treatment with anti–CD20 agents can be guided by B-cell monitoring and should aim to achieve complete depletion. PubMed, Ann Rheum Dis, 07/06/2017. (Also see B Cells and T Cells)
Rituximab usage in systemic lupus erythematosus (SLE)–associated antiphospholipid syndrome (APS): A single–center experience. In this single–center study there were no recurrent thrombotic events after the rituximab therapy, implicating further consideration of large–scale trials to evaluate its therapeutic role in SLE–associated APS patients. PubMed, Semin Arthritis Rheum, 2016 Aug;46(1):102-8. (Also see Antiphospholipid Syndrome)
Tacrolimus (TAC) use in lupus nephritis: A systematic review and meta–analysis. In moderately severe lupus nephritis, there is some evidence supporting efficacy of TAC or multi–target TAC+ mycophenolate (MMF) over IV cyclophosphamide, but no evidence supporting TAC over MMF. PubMed, Autoimmun Rev, Autoimmun Rev, 2016 Jan;15(1):93-101
Vitamin D receptor (VDR) FokI, TaqI, and ApaI polymorphisms and susceptibility to systemic lupus erythematosus (SLE): an updated meta–analysis. This meta–analysis showed that polymorphisms in VDR FokI, TaqI, and ApaI are not associated with SLE susceptibility in overall, European and Asian populations. PubMed, Clin Rheumatol 02/21/2018.
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