Pregnancy and Lactation
NSAIDs should be avoided during the first trimester and just before delivery; they may be used cautiously at other times during pregnancy. NSAIDs appear in breast milk and should be used cautiously by breastfeeding mothers.
Considerations for Health Professionals
History: Allergy to salicylates, other NSAIDs, cardiovascular dysfunction, hypertension, peptic ulcer, GI bleeding or other bleeding disorders, impaired hepatic or renal function, pregnancy, and lactation.
Therapeutic response, including decreased inflammation and adverse effects.
With food or milk (to decrease gastric irritation).
This group of drugs was first developed during World War II because quinine, the standard treatment for malaria, was in short supply. Investigators discovered antimalarials could also be used to treat the joint pain that occurs with rheumatoid arthritis. Subsequent use of antimalarials showed that they are effective in controlling lupus arthritis, skin rashes, mouth ulcers, fatigue, and fever. They have also been shown to be effective in the treatment of DLE. Antimalarials are not used to manage more serious, systemic forms of SLE that affect the organs. It may be weeks or months before the patient notices that these drugs are controlling disease symptoms.
Types of Antimalarials
Mechanism of Action and Use
The anti-inflammatory action of these drugs is not well understood. In some patients who take antimalarials, the total daily dose of corticosteroids can be reduced. Antimalarials also affect platelets to reduce the risk of blood clots and lower plasma lipid levels.
Ophthalmologic: Visual disturbances and retinal changes manifested by blurring of vision and difficulty in focusing. A very serious potential side effect of antimalarial drugs is damage to the retina. Because of the relatively low doses used to treat SLE, the risk of retinal damage is small. However, patients should have a thorough eye examination before starting this treatment and every 6 months thereafter.