How To Treat Lupus Naturally
In 539 patients with systemic lupus erythematosus, organ damage was associated with glucocorticoid therapy compared with controls (356). Oral prednisone 10 mg day for 10 years (cumulative dose 36.6 g) was significantly associated with osteoporotic fractures (RR 2.5 95 CI 1.7, 3.7), symptomatic coronary artery disease (RR 1.7 CI 1.1, 2.5), and cataracts (RR 1.7 CI 1.4, 2.5). Avascular necrosis was associated with high-dose prednisone (at least 60 mg day for at least 2 months RR 1.2 CI 1.1, 1.4). Intravenous pulses of methylprednisolone (1000 mg for 1-3 days) were associated with a small increase in the risk of osteoporotic fractures (RR 1.3 CI 1.0, 1.8).
Extremely large intravenous doses of glucocorticoids given at longer intervals can sometimes be effective when a patient does not respond to conventional high doses. Systemic lupus erythematosus, various rheumatic diseases, and the treatment of renal graft rejection are indications for this type of use (SEDA-6, 331). High doses of glucocorticoids also have an antiemetic effect in patients with cancers.
In autoimmune diseases cyclophosphamide can cause menstrual disorders (oligomenorrhea or sustained amenorrhea) and ultimately sterility or premature menopause. This has been particularly exemplified in lupus erythematosus, and several studies have shown a high prevalence of menstrual disorders or premature ovarian failure in cyclophospha-mide-treated patients, or a significantly higher incidence of both complications compared with other immunosup-pressive regimens or healthy controls (31-33).
An open trial with 3-year follow up has been conducted in 36 patients with catastrophic childhood onset epilepsy (2). The overall responder rate (more than a 50 reduction in seizure frequency) fell with time 69 at 3 months, 66 at 6 months, 47 at 1 year, and 41 at the end of the study. The most frequent adverse effects were anorexia, weight loss, urinary retention, somnolence, nervousness, and insomnia. Other reported adverse effects include skin reactions (including Stevens-Johnson syndrome), various blood dyscrasias, hepatotoxicity, and systemic lupus erythematosus (3).
The more common adverse effects of griseofulvin include headache and a variety of gastrointestinal symptoms. Griseofulvin can cause photosensitivity and exacerbate lupus and porphyria. Cases of erythema multiforme-like reactions, toxic epidermal necrolysis, and a reaction resembling serum sickness have been reported. Proteinuria, nephrosis, hepatotoxicity, leukopenia, menstrual irregularities, estrogen-like effects, and reversible impairment of hearing have been reported rarely (4-6,13). Griseofulvin is teratogenic in animals and has mutagenic and carcinogenic potential, but the significance of these observations for humans is unclear (13).
Mizoribine is mostly well tolerated when it is used to treat different renal diseases, such as vasculitis, lupus nephritis, or nephritic syndrome (1-3). However, hemor-rhagic enteritis and erosive changes in the intestinal mucosa have been found in dogs, and similar adverse effects have been reported in humans (4).
The thiazide diuretics are used cautiously in patients with liver or kidney disease, lupus erythe-matosus (may exacerbate or activate the disease), or diabetes. Additive hypotensive effects occur when the thiazides are given with alcohol, other antihypertensive drugs, or nitrates.
Adverse effects The most common problem with procainamide is lupus-like syndrome. Sixty-five percent of patients will develop antibodies within 12 months only 12 will show symptoms that are reversible when the drug is stopped (19). Rare central nervous system side effects include depression, hallucinations, and psychosis, but gastrointestinal intolerance is less frequent than with quinidine (17).
Over-the-counter products containing colloidal silver or silver salts have been marketed for use in adults and children for a wide variety of diseases, including AIDS, cancer, tuberculosis, malaria, systemic lupus erythemato-sus, syphilis, scarlet fever, herpesvirus infections, pneumonia, typhoid, tetanus, and many others. The US Food and Drug Administration has issued a ruling that a colloidal silver product for any medical use will first have to be approved by the FDA under drug application procedures (11).
Relative contraindications to sulfonamides are systemic lupus erythematosus and a known predisposition to lupuslike reactions. Allergic reactions to antimicrobials are frequent in patients with Sjogren's syndrome. They are especially susceptible to reactions to penicillins, cephalo-sporins, and sulfonamides, but reactions to macrolides and tetracyclines also seem to be over-represented in these patients (210).
The corticosteroids arc grouped according to their capacity for Na+ retention, their effects on carbohydrate metabolism, and their anti-inflammatory effects. Thus, glucocorticoids have pleoiotropic effects and arc used in clinical practice in (as well as replacement therapy in cases of adrenal insufficiency) treating diverse diseases such as inflammatory rheumatic disorders, asthma, autoimmune diseases (systemic lupus erythematosus and others), acute kidney transplant rejection, and allergic and skin diseases. In pregnant women at risk for preterm birth, corticosteroids are also used for the induction of lung maturity. High doses of daily glucocorticoids are usually required in patients with severe diseases involving major organs, whereas alternate-day regimens may be used in patients with less aggressive disease. Intravenous glucocorticoids (pulse therapy) are frequently used to initiate therapy in patients with rapidly progressive, inmunologically mediated diseases (Rournpas 1993).
There is also one case report of a woman treated with hydralazine for PI H in which the fetus died 36 hours after delivery from a pericardial effusion and cardiac tamponade (Yemini 1989). A postmortem examination suggested a lupus-like syndrome possibly due to maternal and fetal sensitivity to hydralazine.
The gold compounds are contraindicated in patients with known hypersensitivity to any component of the drug. Parenteral administration is contraindicated in patients with uncontrolled diabetes, hepatic disease, uncontrolled hypertension, uncontrolled congestive heart failure, systemic lupus erythematosus, and blood dyscrasias and in those with recent radiotherapy. Oral administration is contraindicated in patients with necrotizing enterocolitis, pulmonary fibrosis, and hema-tologic disorders and during pregnancy (Category C) and lactation.
Immunologic Several drugs have been reported to cause a lupus-like syndrome. In a recent review of relevant American and European literature, hepatitis and drug-induced lupus were reported in 66 cases after minocy-cline therapy, mostly after long-term treatment for acne (45R ). It should be recognized that in many countries long-term minocycline is a very common therapy for acne. Based on the strategy that inhibition of an-giogenesis is of importance in anticancer therapy, CMT-3 (COL-3) was recently used in a phase 1 study in 35 patients at the National Institutes of Health in the USA in patients with refractory metastatic cancer (46C). The patients received a test dose of CMT-3, followed by pharmacokinetic testing during daily dosing for 7 days. After a few doses, three patients developed symptoms of drug-induced lupus, and the diagnoses were verified after a few days or weeks. CMT-3 was withdrawn and there was improvement. In a retrospective review of drug safety databases,...
Skin Lupus vulgaris has been reported after Six months after BCG vaccination, an 18-year-old boy developed lupus vulgaris on his right shoulder. He was successfully treated with rifampicin, isoni-azid, and ethambutol. He had had lupus vulgaris after BCG vaccination on his left shoulder 8 years before.
Damage to the fetal retina and inner ear has been linked to chloroquine therapy in pregnancy in these cases, chloroquine was used daily in high doses on a long-term basis (Hart 1964). Such long-term, high-dose therapy may be used for other indications -for instance, in chronic inflammatory diseases. However, small series of patients taking large doses of (hydroxy)chtoroquine during pregnancy for treatment of systemic lupus erythematosus did not show an increased risk of congenital malformations or other adverse effects (Parke 1996 see also Chapter 2.1).
Chloroquine 300 mg week adversely affected the antibody response to human diploid-cell rabies vaccine administered concurrently. The mean rabies-neutralizing antibody titer was significantly reduced on each day of testing (SEDA-13, 806) (8). In contrast, retrospective studies of the response to pneumococcal polysaccharide in patients with systemic lupus erythematosus taking chloroquine or hydroxychloroquine, and of the response to tetanus-measles-meningococcal vaccine in a region of Nigeria where malaria is endemic, did not show an effect on antibody production. However, it was pointed out that the altered immune status of patients with systemic lupus erythematosus makes it difficult to compare their response to that of young healthy adults receiving rabies vaccine. Illness and nutritional state could have influenced the findings in the Nigerian study (SEDA-13, 807) (53).
Antimalarial drugs (chloroquine, hydroxychloroquine, or quinacrine) were given to 36 patients with cutaneous lupus, of whom 17 were smokers and 19 non-smokers (8). The median number of cigarettes smoked was one pack day, with a median duration of 12.5 years. There was a reduction in the efficacy of antimalarial therapy in the smokers. Patients with cutaneous lupus should therefore be encouraged to stop smoking and consideration may be given to increasing the doses of antimalarial drugs in smokers with refractory cutaneous lupus before starting a cytotoxic agent.
Immunoglobulin solutions contain primarily immunoglobulin-G (IgG) antibodies, and are produced from pooled human plasma. The extent to which IgG antibodies pass through the placenta is dependent on the gestational age, the dosage, the length of treatment, and the kind of preparation given. However, Fab fragments do not pass (Miller et al. 2003). Immunoglobulins are used for different maternal or fetal indications - for example, in cases of antibody deficiency or infectious diseases (especially as a preventive measure), to improve the symptoms of some maternal autoimmune diseases, or to treat the symptoms of some fetal conditions (such as, for instance, heart block in the fetuses of mothers with lupus erythematosus).
This therapy (preferably in combination with low molecular-weight heparins) is found to be effective in preventing recurrent pregnancy loss and other pregnancy complications in women with antiphospholipid syndrome, as in systemic lupus erythematosus (see also Chapter 2.9.2). Many studies indicate a benefit of low-dose aspirin, in combination with LMWHs or alone, in the treatment of high-risk thrombophilic pregnant women other studies do not confirm these findings. In one meta-analysis, aspirin treatment seemed to have, for women with moderate and high risk, a small but significant effect on reducing the rate of preterm birth, but it did not reduce the rate of perinatal death (Kozer 2003). The use of low-dose aspirin for preventing recurrent pregnancy loss and other serious obstetrical complications in women with thrombophilia remains a subject for debate (Robertson 2005, Bates 2004, Gris 2004, Brenner 2003).
Antimalarial drugs (chloroquine, hydroxychloroquine, or quinacrine) were given to 36 patients with cutaneous lupus, 17 smokers and 19 non-smokers (48). The median number of cigarettes smoked was one pack day, with a median duration of 12.5 years. There was a reduction in the efficacy of antimalarial therapy in the smokers. Patients with cutaneous lupus should therefore be encouraged to stop smoking and consideration may be given to increasing the doses of antimalarial drugs in smokers with refractory cutaneous lupus before starting a cytotoxic agent.
In dermatological practice, thalidomide has also been used to treat patients with various diseases that are unresponsive to conventional therapy. Among these are aphthous stomatitis, Behcet's disease, discoid and systemic lupus erythematosus, uremic pruritus, actinic prurigo, prurigo nodularis, sarcoidosis, adult Langerhans cell histiocytosis, erosive lichen planus, and pyoderma gangrenosum (5). There has also been research on a possible antineoplastic action of thalidomide (6), which may be produced via antiangiogenic effects or direct effects on tumor cells, such as induction of apoptosis or G1 arrest of the cell cycle, inhibition of growth factor
LJP 394 is an investigational drug under development as a selective immunomodulator for the treatment of systemic lupus erythemato-sus. It reduces serum dsDNA antibodies and splenic dsDNA antibody-producing cells in BXSB mice and causes improved renal function and histopathology, as well as prolonged survival (150E). In a phase 2, partially randomized, doubleblind, placebo-controlled study of three different doses of LJP394 in 58 patients, seven did not receive all doses of LJP394 because of adverse events (151c). Five withdrew because of adverse events related to their lupus erythematosus non-renal exacerbations in two, hematuria and hypertension in one, worsening rash in one, and nephritis in one. One patient withdrew because of cellulitis and another because of a localized Herpes zoster infection. None of the reported adverse events was considered to be definitely related to the drug. 62. Bleumink GS, Ter Borg EJ, Ramselaar CG, Stricker BHC. Etanercept-induced subacute cutaneous...
A 300 mg dose of rifabutin is usually well tolerated. Adverse effects include neutropenia, thrombocytopenia, rash, and gastrointestinal disturbances (nausea, flatulence). Myositis (12) and uveitis (13) are rarely observed. The drug-induced lupus-like syndrome has been linked in a few cases with rifampicin and rifabutin.
Rifampicin given in usual doses (for example 10 mg kg day) is well tolerated and causes adverse effects in only about 4 of patients. Adverse reactions are predominantly hepatic and allergic. Gastrointestinal symptoms are generally transient. Risk factors are age, alcoholism, and hepatic disorders (1). As a potent microsomal enzyme inducer, rifampicin shortens the half-lives of many other drugs (1). This effect occurs after about 7 days and persists for a few days after withdrawal. Allergic reactions can cause rashes (in 0.8 ), fever, a flu-like illness (malaise, headache), eosinophilia, and much less often hemolytic anemia, hemoglobinuria, and kidney damage with acute renal insufficiency. These reactions occur especially during intermittent treatment (less than twice weekly) or after re-introduction of rifampicin. Anaphylactoid reactions to rifampicin have been described in HIV-positive patients (7). Light-chain pro-teinuria and concomitant kidney damage are attributed to an...
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