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