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    Medications Used to Treat Lupus

    Antimalarials continued...

    Dermatologic: Dryness, pruritus, alopecia, skin and mucosal pigmentation, skin eruptions, and exfoliative dermatitis.

    Hematologic: Blood dyscrasia and hemolysis in patients with glucose 6-phosphate dehydrogenase (G6PD) deficiency.

    Pregnancy

    Antimalarials are considered to have a small risk of harming a fetus and should be discontinued in lupus patients who are attempting to become pregnant.

    Considerations for Health Professionals

    Assessment

    History: Known allergies to the prescribed drugs, psoriasis, retinal disease, hepatic disease, alcoholism, pregnancy, and lactation.

    Laboratory data: CBC, liver function tests, and G6PD deficiency.

    Physical: All body systems to determine baseline data and alterations in function, skin color and lesions, mucous membranes, hair, reflexes, muscle strength, auditory and ophthalmological screening, liver palpation, and abdominal examination.

    Evaluation

    Therapeutic response and side effects.

    Administration

    Before or after meals at the same time each day to maintain drug levels.

    Corticosteroids

    Corticosteroids are hormones secreted by the cortex of the adrenal gland. SLE patients with symptoms that do not improve or who are not expected to respond to NSAIDs or antimalarials may be given a corticosteroid. Although corticosteroids have potentially serious side effects, they are highly effective in reducing inflammation, relieving muscle and joint pain and fatigue, and suppressing the immune system. They are also useful in controlling major organ involvement associated with SLE. These drugs are given in much higher doses than the body produces and act as potent therapeutic agents. The decision to use corticosteroids is highly individualized and is dependent upon the patient's condition.

    Once the symptoms of lupus have responded to treatment, the dose is usually tapered until the lowest possible dose that controls disease activity is achieved. Patients must be monitored carefully during this time for flares or recurrence of joint and muscle pain, fever, and fatigue that can result when the dosage is lowered. Some patients may require corticosteroids only during active stages of the disease; those with severe disease or more serious organ involvement may need long-term treatment.

    Treatment with corticosteroids must not be stopped suddenly if they have been taken for more than 4 weeks. Administration of corticosteroids causes the body's own production of adrenal hormones to slow down or stop, and adrenal insufficiency will result if the drug is stopped suddenly. Tapering the dose allows the body's adrenal glands to recover and resume production of the natural hormones. The longer a patient has been on corticosteroids, the more difficult it is to lower the dose or discontinue use of the drug.

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