BARK DI TRUTE :: Systemic Lupus Erythematosus

12 May 2021 1:26 PM | Anonymous

BARK DI TRUTE

Posted by Vernon Lloyd Derby at 22:00 

Dr. Winsome Beverley Christie
President of the Pharmaceutical
Society
 of Jamaica

According to the Centre for Disease Control and Prevention (CDC, 2013, )Systemic lupus erythematosus (SLE), is the most common type of lupus. SLE is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels. There is no cure for lupus, but medical interventions and lifestyle changes can help control it.


Brittney Taylor
Assistant Secretary of the
Pharmaceutical Society
of Jamaica

 Prevalence of Systemic Lupus Erythematous in Blacks

In recent years, SLE has been on radar as that autoimmune disease that is seen on the rise amongst both sexes of all ethnic groups. Interestingly, approximately ninety percent (90%) of SLE cases are seen in women. Of all the ethnic groups the rates appear to be higher inblack women. (Danchenko et al.,2006).

An ethnic diverse study conducted in Michigan, concluded that the prevalence of SLE was 10-fold higher in females, with a 1 in 537 approximationsin black females. (Somers et al., 2014) Although, the prevalence appears to be higher in black women, the rates vary for black women living in different areas of the world.For example, reports from an early study done solely on black people in West Africa, proved the prevalence of SLE to be rare however, the ratesin said women living in America, the Caribbean and Europe was relatively high (Symmons DP, 1995).

Kevar Bennett
 Secretary of the Pharmaceutical
Society of Jamaica.

Sang-Cheol B et al. highlighted in a review, that the prevalence of SLE progressively increased as blacks migrated from Africa to both North America and Europe suggesting that dietary and environmental contributions may have influenced the rates.  A common finding that was noted in various epidemiological studies done over the years;is that the prevalence of SLE in blacks tends to be higher than that observed in otherethnic groups.  (Lewis and Jawad, 2014). According to a study conducted by the University Hospital of the West IndiesDepartment of Medicine in 2008, a Lupus Registry was established to help with the analysis of the data and it was concluded that a total of 107 patients met the criteria for diagnosis of SLE at the referral centre, 96.3% of them female. Positive antinuclear antibodies[ANA ] (90.7%), arthritis (70.0%), malar rash (53.5%) and a positive dsDNA (40.1%) were the more frequent manifestations and diagnostic indices of the disease. Up to 41.7% of the SLE population suffered some form of complication.

SLE AND COVID

Several autoimmune rheumatic diseases such as systemic lupus erythematosus (SLE) result from immune-mediated inflammation and tissue damage caused by immune system dysregulation. As a result, patients with autoimmune rheumatic disease have been identified as a vulnerable population at risk for severe COVID-19 illness. Although a strong antiviral immune response is needed for viral clearance, hyperactive immunity has been linked to cytokine storm and tissue damage in COVID-19 patients . Both SLE and COVID-19 have been shown to manifest multi-organ complications of interstitial pneumonia, cytopenia, arthralgia, myocarditis, and hemophagocytic lymphohistiocytosis . Due to similarities in disease characteristics, treatment of patients with SLE may provide insights into development of therapeutic options for COVID-19.

Lupus treatment

The treatment modalities will focused on two types of lupus: Discoid lupus and Systemic Lupus Erythematosus.

Discoid lupus is a skin problem that causes raised red areas (called "plaques") and scars on the skin. Discoid lupus can happen anywhere on the skin but usually happens on the upper body. The most common places for discoid lupus are the face, neck, scalp, and ears.

 Symptoms of discoid lupus: red, scaly plaques. These plaques tend to slowly expand at the edges and then heal. When they heal, they leave behind discolored skin and sunken scars. Discoid lupus on the scalp can cause hair loss.

Sometimes, people with discoid lupus also have lupus in other parts of the body. This is called "systemic lupus." But most people with discoid lupus just have lupus in their skin.

Treatment involves mainly topical applications but can include corticosteroids and medication similar to those used for the more generalized systemic lupus erythematosus.

  • Steroid medicines that come in ointments, creams, or gels – These steroid medicines reduce inflammation and help the skin heal. Examples include fluocinonide or clobetasol.
  • Medicines called calcineurin inhibitors that come in ointments or creams. Examples include pimecrolimus (brand name: Elidel) and tacrolimus (brand name: Protopic).
  • Steroid medicines that come as injections, are given locally into the portion of skin that is affected.          

Sytemic lupus erythematosus treatment depends on symptoms and how the person is feeling. The goals of treatment include:

  • Ease your symptoms
  • Bring down inflammation
  • Prevent and relieve flares
  • Prevent organ damage and other health problems

Pain and inflammation associated can be treated with non-prescription drugs such as

  • Acetaminophen
  • Aspirin
  • Ibuprofen
  • Naproxen

Antimalarial drugs Pain Antimalarial Drugs such as

hydroxychloroquine" or "chloroquine

They might help with skin rashesmouth sores, and joint pain. They may also lower your chance of blood clots, which is a concern in some people with lupus.

Antimalarial drugs protect against skin damage from ultraviolet rays in sunlight and may protect your body against organ damage linked to lupus.

Corticosteroids

These can be a pill form or IV, they work fast to ease swelling, warmth, and soreness in joints that’s caused by inflammation. They can also prevent long-term organ damage.

Corticosteroids can have serious side effects like:

You may also have weight gain, bloating, and mood changes. Your doctor will probably give you the lowest dose they can and taper it off if your symptoms go away for a time.

Immunosuppressive drugs

Like corticosteroids, these drugs curb your immune system, bring symptoms under control, and help prevent long-term organ damage. Your doctor may prescribe them if corticosteroids haven’t helped your symptoms.

Common immunosuppressive drugs for lupus include:

  • Azathioprine (Imuran)
  • Cyclophosphamide (Cytoxan)
  • Methotrexate (Rheumatrex)

In some cases, you may use immunosuppressive drugs along with corticosteroids. That way, you'll be taking a lower amount of each type of drug, reducing the possible side effects.

With both types of drugs, you and your doctor need to weigh the risks of side effects against how well they ease your lupus symptoms.

Side effects of immunosuppressive drugs

Immunosuppressive can make it hard for your body to fight infections and raise your chances for some kinds of cancer. One particular immunosuppressive drug azathioprine may cause pancreatitis or a form of hepatitis. Cyclophosphamide may lead to bladder problems, hair loss, or fertility problems. Methotrexate can cause nausea, headaches, mouth sores, sun sensitivity, lung infections, and liver damage.

Your doctor may also prescribe one or more of these types of drugs:

  • Anticoagulants. These thin your blood to prevent clots, a life-threatening lupus symptom.
  • Monoclonal antibodies. Belimumab (Benlysta) is the first drug created just to treat lupus. Given intravenously (in a vein) or subcutaneously (under your skin), it targets specific immune cells. It may help reduce your need for steroid treatment, but it hasn’t been tested thoroughly for the most severe forms of lupus. Rituxan (Rituximab) is another monoclonal antibody that can sometimes treat lupus when other treatments haven’t worked.
  • Repository corticotropin injection. A medicine called H.P. Acthar Gel may help your body make its own steroid hormones like cortisol to fight inflammation.

Side effects of other medications

Common side effects of anticoagulants include bloating, diarrhea, upset stomach, vomiting, and loss of appetite. You may rarely have bruising, a skin rash, a sore throat, back pain, or yellow skin and eyes (jaundice).

Monoclonal antibodies might cause problems like headache, nausea, hives, or blood pressure changes. These can usually go away over time.

Acthar Gel may cause swelling, changes in blood pressure or glucose tolerance, mood changes, stronger appetite, or weight gain.

Complementary treatments for Lupus can be supportive and aimed at reducing stress, improving the immune system and reducing inflammation and pain. They may include:

Talk to your doctor or pharmacist before trying any alternative or complementary treatments for lupus. Also ask your pharmacist to run a drug interaction on their “system” to see if there are any potential or real interactions.

Lifestyle Changes

A healthy lifestyle will help you feel better and prevent flares. It can also help prevent problems linked to lupus, like kidney diseaseheart attack, and stroke.

Try these tips:

For Discoid lupus some tips to help cope with the disease include but may not be limited to:

  • Staying out of the sun in the middle of the day (from 10 AM to 4 PM), when the sun's light is strongest
  • Stay under a sun umbrella, tree, or other shady spot
  • Wear sunscreen – Put sunscreen on all parts of the body that are not covered by clothes. Then reapply sunscreen every 2 to 3 hours, or after you sweat or swim. It's important to choose a sunscreen that:
  • Has an SPF of 30 or greater – SPF is a number that tells you how well a sunscreen protects the skin from UV light.
  • Protects against 2 types of UV light, called "UVA" and "UVB." (Sunscreens that offer both UVA and UVB protection are sometimes called "broad spectrum.")
  • Has not expired or is not more than 3 years old
  • Wear a wide-brimmed hat, long-sleeved shirt, and long pants
  • Do not use tanning beds
  • If you smoke, it's a good idea to quit. Discoid lupus seems to be more severe in people who smoke. Also, smoking seems to make certain medicines for discoid lupus less effective.
If you are bothered by the way discoid lupus looks on your skin, you can use special cosmetic products to make the skin changes less obvious.

 Contributors:

  • Dr. Winsome Beverley Christie, President of the Pharmaceutical Society of Jamaica,
  • Kevar Bennett, Secretary of the Pharmaceutical Society of Jamaica.
  • Brittney Taylor Assistant Secretary of the Pharmaceutical Society of Jamaica,

References

Bae SC, Fraser P, Liang M. The epidemiology of systemic lupus erythematosus in populations of African Ancestry. Arthritis & Rheumatism 1998; 41:2091-2099

Danchenko N , Satia JA, Anthony MS. Epidemiology of systemic lupus erythematosus: a comparison of worldwide disease burden. Lupus 2006; 15:308-18

Lewis MJ, Jawad AS. The effect of ethnicity and genetic ancestry on epidemiology, clinical features and outcome of systemic lupus erythematosus. Rheumatology 2017; 56:67-77

Somers EC, Marder W, Cagnoli P et al. Population-based incidence and prevalence of systemic lupus erythematosus: the Michigan Lupus Epidemiology and Surveillance program. Arthritis Rheumatol 2014; 66:369-78

Symmons DP. Frequency of lupus in people of African origin. Lupus 1995; 4:176-8

Discoid Lupus

https://online.lexi.com/lco/action/doc/retrieve/docid/disandproc/3634237?cesid=23AbZOOrhGy&searchUrl=%2Flco%2Fa

 Lupus Treatment

https://online.lexi.com/lco/action/doc/retrieve/docid/disandproc/4734765?cesid=7oZ8qt5MQEP&searchUrl=%2Flco%2Fa

Complementary and Alternative (CAM) Treatments of Lupus-LUPUS UK

Lupus Treatment: Medications and Alternative Treatments (webmd.com)

https://www.frontiersin.org/articles/10.3389/fimmu.2020.589474/full

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New Engl J Med (2020) 382:1708–20. doi: 10.1056/NEJMoa2002032



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