Drug therapy essential in treating lupus

Drug therapy essential in treating lupus

By Maria Endah Hulupi

JAKARTA (JP): "Rita" was an active young woman who woke up one
morning complaining of painful joints. She felt better after
seeing a rheumatologist, but a few days later an awful rash
developed on her face and she had a mouth ulcer.

Her face swelled and she suffered kidney problems. Doctors
gave her different diagnosis and different courses of drugs. The
nun became depressed, feeling that God had abandoned her.

And then one of the doctors told her that she had Syndrome
Lupus Erythematosus (SLE). She did not really understand the
condition and was under supervision of three different
specialists.

She took no less than a dozen types of drugs three times a
day, but she was still in pain. The only thing that kept her sane
was the support of her friends, family and doctors. She has
recovered but continues to need drug therapy.

A hematologist consultant with Cipto Mangunkusumo General
Hospital, Zubairi Djoerban, said lupus is a noncontagious
systemic autoimmune disease of unknown cause. It may manifest in
one or more health problems, with symptoms ranging from mild to
serious.

There are three types of lupus: Discoid lupus is the mild
type, which manifests in disorders of the facial skin, neck and
scalp. More serious are systemic lupus erythematosus, which will
affect the blood and vital organs like the kidneys, lungs and
brain, and drug-induced lupus, which occurs as a result of taking
medication such as isoniazid (used to treat tuberculosis),
quinidine, hidralazine and procainamide.

Diagnostic parameters to detect lupus include rash across the
cheeks, fatigue, anemia, lesion rash, U.V. sensitivity, hair
loss, arthritis, oral ulcers, fever, inflammation in the lungs,
heart or abdomen, kidney disease, blood disorders and immunologic
abnormalities.

"When four of the parameters are detected, she or he may have
lupus," he said during a recent discussion held by the Indonesian
Lupus Foundation and the School of Medicine of the University of
Indonesia.

He explained that when the human body was invaded by virus and
bacteria, as a line of defense, the body produced antibodies to
fight them. But in cases of lupus, there is an overproduction of
antibodies and instead of fighting against disease-causing
viruses and bacteria, the antibodies attack the body elements and
organs.

The cause of the disorder is still unknown, but Zubairi
said genetic and environmental factors, like infections, drugs
that increase allergic reactions, U.V. light and stress might
contribute to the problem.

Female hormones may also be involved; nine out of 10 adult
patients are women, but the ratio between boys and girls with
lupus is almost equal in child sufferers.

The Indonesian Lupus Foundation (YLI) said it had about 200
active lupus sufferers from about 500 sufferers nationwide. Data
showed that in the United States there were some 500,000 to one
million sufferers with around 16,000 new cases annually.

He said patients needed to drug therapy under the supervision
of a team of specialists to help relieve their ailments and
enable them to resume their daily activities.

"Continuous drug therapy is needed to control the problems.
Sufferers would have to take high doses of different drugs in the
beginning of the therapy, but the doses would be reduced
progressively to determine the lowest dose possible for the
person."

Drug therapy helps keep the fatality rate below 10 percent.

"Some people can terminate their drug therapy, but others
would have to keep taking medications for the rest of their
lives," he said.

Rheumatologist Yoga Iwanoff Kasjmir from YLI said flare-ups
could occur but they could also be prevented. He said lupus
sufferers needed to exercise regularly (but not overdo it), avoid
taking certain drugs that would trigger flare-ups, avoid
dehydration and remain active but avoid doing tasks that might
strain affected joints.

They must get enough rest and sleep, avoid people with
tuberculosis, throat infections or conjunctivitis which may
irritate their conditions.

As U.V. lights can trigger flare-ups, Yoga warned sufferers to
limit sun exposure by protecting themselves with a hat, umbrella
and sunblock.

"It is better to schedule outdoor activities or exercises,
such as swimming, early in the morning or late in the afternoon,"
he said.

Yoga said that doctors might prescribe antimalarial drugs as
medication as it contained chloroquine that would protect against
U.V. light and soothe arthritic pain. Other medications may
include nonsteroidal antiinflammatory drugs, immunosuppressive
drugs and steroids.

Unfortunately, long-term effects of the drug therapy may
include dental problems and osteoporosis.

Pregnancy

Zubairi assured that women with lupus could have babies.

"However, proper timing is very important. Women with SLE,
especially when their vital organs are being treated, are not
advised to get pregnant until they are physically ready," Zubairi
said.

For contraceptive methods, spermacides, diaphragm and condom
are highly recommended because women with lupus are not advised
to take hormonal contraceptive pills.

Zubairi explained that repeated miscarriages could occur and
the most common cause was called antiphospholipid antibody
syndrome (APS), which led to the production of abnormal
antibodies.

"The syndrome may increase risk of thromboembolism or blood
clots and thrombocytopenia, which can cause hemorrhaging. This
will lead to abortion," he said.

He said doctors might prescribe heparin, aspirin, prednison
immunoglobulin or recommend plasmapheresis to prevent abortion.

Monitoring by specialists is needed to ensure healthy fetal
growth and treat their problems.

More information about lupus can be obtained at Yayasan Lupus
Indonesia: tel. (021) 478.68.336 e-mail: yli-
indo@link.net.id;Ikatan Rheumatologi Indonesia: tel. (021)
330.166 e-mail: reumatik@indosat.net.id; and Perhimpunan SLE
Indonesia: tel. (021) 330.166