Working+Draft



The Fight to Treat Lupus
 * The copy below is the rough draft. The final is in the attachments above.

If there is one disease that is able to attack every part of the body, it is lupus. Lupus is an autoimmune disease that cannot be cured and is difficult to treat because of the way it can attack any part of the body and it leads to many other diseases. “There are many categories of drugs for the treatment of lupus. Of all these drugs, only a few are approved specifically for lupus by the Food and Drug Administration…However, many medications are used to treat the symptoms of lupus” (Treatments for Lupus). Lupus is unable to be cured, but there are medications that are able to treat it and make living with lupus more comfortable. Because there has not been a specific medication created for lupus in many years, doctors “borrow” medications from other illnesses to help treat lupus; which is appropriate because lupus attacks the entire body, causing a variety of other ailments, which may require one patient to have many treatments. People who have lupus see many doctors in order to obtain treatment.

Most see a rheumatologist, which is a doctor that treats the joints and muscles. Patients also have other doctors who treat the other specific parts of the body that their case of lupus attacks. For example, one with cutaneous lupus would see a dermatologist for their skin and one with kidney problems affected by lupus would see a nephrologist. Pregnant women who have lupus would see an obstetrician to monitor the high-risk pregnancy.

Almost all lupus patients suffer the discomforts of inflammation. “Anti-inflammatories are the most common drugs used to treat lupus, particularly symptoms such as fever, arthritis or pleurisy, which generally improve within several days of beginning treatment” (Medications to Treat Lupus). Even though anti-inflammatory medications help most patients, all of them have negative side effects. A few anti-inflammatory medications are asprin, acetaminophen (Tylenol ®), and non-steroidal drugs such as Motrin ®, naproxen, and Celebrex ®. Asprin is not expensive and does not require a prescription but can cause stomach problems. Tylenol ®, when taken too much can affect the liver. Non-steroidal anti-inflammatory drugs can cause stomach irritation and gastrointestinal problems.

“Corticosteroids (also known as glucocorticoids, cortisone or steroids) are synthetic (man-made) drugs designed to work like the body’s naturally occurring hormones produced by the adrenal glands, in particular cortisol” (Medications to Treat Lupus). Corticosteroids are not like the steroids that weight lifters and athletes use. They are used to reduce inflammation and regulate blood pressure and the immune system. “Steroid medications work quickly to decrease the swelling, warmth, tenderness, and pain that [is] associated with inflammation” (Medications to Treat Lupus). Some steroids are taken by mouth, some in forms of cream, some through IV and some are injected directly into the muscle. The most common steroid is prednisone ®, which is also a medication taken for many other diseases. There are side effects of steroids such as acne, weight gain, fluid retention, easy bruising and many other side effects that effect one mentally. Also, there are many long-term side affects that can potentially be life changing.

Another type of steroid is called DHEA, which is available over the counter has been tested to treat lupus. Before treating lupus it was used as a sexual enhancer, cancer preventative and many other things. “But when it comes to mitigating the pain and inflammation of //lupus//, a type of arthritis in which the body's immune system attacks its own healthy cells, Timothy McAlindon, MD, Chief of Rheumatology at the Tufts-New England Medical Center, says, "I think there is an emerging role for it” (Supplement Shows Promise for Treating Lupus). It can help women with an estrogen/testosterone balance, which is commonly found in lupus. Because it affects hormones in both men and women it introduces the risk for gender-based cancers. Some parts of the body require certain amount of hormones, which this medication may affect.

Antimalarials are used to treat lupus, but only along with another medication. Their main purpose serves to reduce the doses of other dangerous medications such as steroids and to reduce side effects. “Antimalarials are most often prescribed for skin rashes, mouth ulcers, and joint pain, but also can be effective in mild forms of lupus where inflammation and blood clotting are a concern. Antimalarials improve lupus by decreasing autoantibody production, protecting against the damaging effects of ultraviolet light from the sun and other sources, and improving skin lesions” (Medications to Treat Lupus). It takes more time for these drugs to work, opposite from the rapid relief of other drugs used to treat lupus. Two examples of antimalarials are Plaquenil ® and Aralen ®. In low doses, one may experience non-serious side effects such as change in skin color and upset stomach but in high doses one may experience retina damage. Even though these side effects can be uncomfortable, they are much less serious than the side effects of other drugs.

“Immunosuppressive medications are used to control inflammation and the overactive immune system, especially when steroids have been unable to bring lupus symptoms under control, or when a person cannot tolerate high doses of steroids” (Medications to Treat Lupus). Even though these medications are effective, they lower the power of ones immune system. Even of the smallest cut our wound can be serious to one who takes immunosuppressive medication. They are more susceptible to common illness and can obtain viral infections much easier than others who do not take the medication.

Two examples of immunosuppressive drugs are Cytonax ® and Rheumatrex™, which were originally developed to fight cancer. Cytonax is taken through IV and can help with the kidneys and lungs. Rheumatrex helps treat rheumatoid arthritis, which is one of the most common diseases that come along with lupus. “Now, doctors at Johns Hopkins' University School of Medicine's Lupus Center report amazing results with high doses of cyclophosphamide, a cancer drug that's also used in lower doses as a lupus treatment” (Dellapena). When 14 people with severe lupus received the high-dose therapy for 4 days, symptoms eased for most. More than 2 1/2 years later, 5 of 14 patients remained free of lupus (Arthritis & Rheumatism, Jan 2003). Another medication is Imuran ®, which helps lower steroid dosage and helps improve the liver and kidneys. This medication was originally made to help the rejection of kidney transplants.

Most think that chemotherapy can only be used to fight cancer, but it is being tested to see if it can help patients fight lupus. Chemotherapy may hold hope in the future for those with severe lupus who can no longer be treated with standard medication. “In an attempt to "reset" the immune system, researchers first harvested and separated bone marrow stem cells from the patient's own blood. These cells develop into immune cells…Once returned to the body, the stem cells repopulated the bone marrow and reform a functioning immune system. According to Burt, the transplanted stem cells can avoid developing into cells with dangerous autoimmune traits because their genes do not necessarily predetermine the disease” (Khamsi).

Anticoagulant drugs are used to prevent blood clots in lupus patients. Some examples of these are Calciparine®, Liquaemin® and Coumadin®. Everyone responds to these medications differently, which require them to be closely monitored by a physician. Genetic make up influences how one responds to these mediations. Since there are few treatments specifically for lupus, doctors and researchers conduct clinical trials to test treatments for other diseases on lupus patients. Some examples are stem cell transplant, DHEA, and Rituximab. Stell cell transplants take ones own stem cells to try and rebuild the immune system. “The treatment substantially improved the condition of about half of the lupus patients, all of whom had stopped responding to standard therapy. But the treatment still carries real risks and medical experts caution against calling it a cure” (Khamsi). DHEA, which has already been discussed, is now being tested in trials to see how it treats lupus and how affective it is. “Rituximab decreases the number of B cells, a type of white blood cell, in your body and has shown some promise in treating lupus in people who haven't responded to other immunosuppressants. However, rituximab has been linked to a fatal brain infection in two people with lupus” (Mayoclinic).

“Now, what about borrowing from other diseases? We have to do a lot of that in lupus” (Petri). Some “borrowed” Medications include Plaquenil, Anti-DNA anibody inhibitor (LJP394), and CellCept. Plaquenil helps the immune system without making those who use it as susceptible to other illnesses. Other immunosuppressive drugs are known to make others susceptible to other illnesses. Plaquenil can be used long-term because it is safe. “There is a huge study of a compound called LJP394 to see if this can prevent the production of the anti-DNA antibodies in lupus. The hope would be that if you could get rid of the anti-DNA antibodies, people wouldn't get kidney disease” (Petri). CellCept is a trial for those with kidney lupus. It is a low-risk treatment and does not cause infertility like some other kidney drugs. These drugs are still being tested.

Unlike most diseases, lupus has the ability to attack any part of the body and is a promoter for one to develop other illnesses. Because of this, it becomes difficult to treat lupus. Doctors and researchers “borrow” medication from other disease to help treat this life-threatening, incurable illness. It is amazing how treatments such as chemotherapy can be tested to treat lupus. Trials are becoming more and more successful and there is hope for those with lupus, even if it is a severe case that cannot be helped with traditional treatments.

A) Dellapena, Deb. "Old drug--new hope. (On The Horizon).(cyclophosphamide)(Brief Article)." //Prevention.// 55. 7 (July 2003): 164(1). //Student Resource Center - Health Module// . Gale. Springfield Township High School. 12 Oct. 2009 . B) Fackelmann, Kathy A. "Gene therapy corrects mouse lupus. (results of research may help human lupus erythematosus patients)." //Science News.// v145. n12 (March 19, 1994): p180(1). //Student Resource Center - Health Module//. Gale. Springfield Township High School. 12 Oct. 2009 < http://find.galegroup.com/srcx/infomark.do ? &contentSet=IAC- Documents &type=retrieve &tabID=T003 &prodId=SRCHlth &docId=A14947824 &source=gale &userGroupName=erde79591 &version=1.0>. C) Khamsi, Roxanne. "Stem cell transplants offer hope against lupus ." //New// //Scientist// . N.p., 2009 . Web. 9 Oct. 2009. . D) Mayo Clinic Staff. "Lupus: Treatments and drugs." //Mayo Clinic//. N.p., 5 June 2008. Web. 9 Oct. 2009. . E) "Medications to Treat Lupus." //Lupus Foundation of America// . N.p., 2009. Web. 8 Oct. 2009. . F) Petri, Michele. "Lupus Information." //The Johns Hopkins//. John's Hopkins Arthritis Center, 2009. Web. 9 Oct. 2009. . G) "Supplement Shows Promise for Treating Lupus." //Tufts University Health & Nutrition Letter// 21.2 (2003): 6. //Health Source - Consumer Edition// . EBSCO. Web. 12 Oct. 2009. H) "Treatments for Lupus." //Lupus Foundation of America//. N.p., 2009. Web. 8 Oct. 2009. .