Treatments: medications, surgery and lifestyle
Before any treatment recommendation is made, your doctor or specialist will ensure that testing is done with great care. Testing as part of the diagnosis process can reveal a lot about how lupus is affecting your body, and as such determine the best course of treatment for your specific signs and symptoms.
Treatment won’t remain the same. As symptoms flare and abate, your treatment plan will need to be adapted to effectively manage the condition.
Treatments and lifestyle changes are helping those with the condition to live longer and better quality lives. But there is no known cure for lupus, as yet.
Treatment will focus on ways and means to reduce inflammation in the body, help prevent or relieve flares, as well as prevent further damage to organs and other areas of the body.
Medications commonly recommended include:
- NSAIDs (Non-steroidal anti-inflammatory medications): Pain, fever and swelling symptoms can be treated with over-the-counter and prescribed medications. NSAIDs can lead to problematic side effects like kidney problems, stomach bleeding and a higher risk of heart concerns, so it is always a good idea to discuss with your doctor be taking any on your own.
- Antimalarial medications: Commonly used in the treatment of malaria, these medications are also effective with controlling symptoms of joint pain, mouth sores or skin rashes. Side effects are common and can include eye retina damage (although rarely) and stomach upsets.
- Corticosteroids: These medications can help counter symptoms of inflammation by weakening an overactive immune system, but should be used with caution as higher doses can produce long-term side-effects. These can include weight gain, osteoporosis (thinning bones), diabetes, easy bruising, high blood pressure, as well as a higher risk of infection. Corticosteroids work fast to ease swelling, warmth and pain in joints and can help to prevent long-term organ damage.
- Immunosuppressants: In more severe cases of lupus these medications are useful in suppressing the immune system and can also help with preventing any long-term organ damage. Side-effects include an increased risk of infection, decreased fertility, liver damage and a higher risk of cancer. Somewhat milder side-effects are symptoms of nausea, diarrhoea and fever. Immunosuppressants are some also prescribed together with corticosteroids, allowing you to take a lower dosage of each drug and thereby, reduce debilitating side-effects.
- Anticoagulants and monoclonal antibodies: Anticoagulants assist with thinning of the blood and preventing blood clots, which can be life-threatening for those suffering from lupus. Monoclonal antibodies target specific immune cells and help alleviate the need for steroid treatment. Monoclonal antibodies are often given intravenously (through a vein).
Your doctor will not suggest any kind of surgical procedure for mild or moderate symptoms of lupus. It will only likely be considered in cases where permanent or life-threatening kidney damage is determined. Kidney transplants or kidney dialysis may be recommended instead of a long-term treatment plan involving high dosage medications due to serious side-effects which can be experienced.
Lifestyle changes and home care
Changes to your lifestyle as a lupus sufferer are just as important as a medication treatment plan. Simple changes will have a big impact on the amount of and severity of flare-ups should they occur. Lifestyle changes will help you better cope with the condition. Things you can actively do include:
- Regular check-ups with your doctor or rheumatologist (and not just when symptoms worsen). If you have kidney problems or related flare-ups, your rheumatologist will do routine blood tests to ensure that your kidneys are functioning well.
- Ensuring that you get adequate rest. Persistent fatigue as a symptom of lupus isn’t necessarily relieved by normal amounts of rest during the day. You will need to assess your own body and symptoms of fatigue and gauge when you need to slow down, take good quality breaks or naps, as well as a good night’s sleep.
- Ease levels of stress and anxiety with activities (such as yoga, meditation or tai chi) you enjoy. You can also get into the habit of using reminders if memory problems are the source of your worries. Pillboxes, cell phone voice notes, labels and other aids can help you with organisation and remembering things important to you.
- Ensuring that you are actively sun-smart. Wear protective clothing (hats, long-sleeved shirts and long trousers), and use sunscreens with an SPF (sun protection factor) of at least 55 every time you go outside. You can also take precautions when it comes to protecting your scalp and hair. Use a baby shampoo and conditioner and avoid the use of any harsh chemicals.
- Get regular exercise. This helps the body recover from a flare-up, strengthen the heart and lungs, as well as reduce the risk of heart attacks, help fight symptoms of depression and in general, promote overall well-being. Activities that are easy on the joints include walking, swimming, low-impact aerobics, yoga, pilates or using an elliptical machine.
- Ease joint and muscle pain (or stiffness) with a warm shower or bath, heating pads (or cold packs). Where joint pain and stiffness is a problem, avoid high-intensity exercises.
- Eat a balanced (healthy) diet. Diet and nutrition is fuel for your body. A healthy diet rich in fruits, vegetables and whole grains are beneficial for a person suffering from lupus, helping to keep weight, blood pressure and cholesterol under control. It can also help reduce risk of other health concerns such as high blood pressure, kidney damage or gastrointestinal problems.
- Don’t smoke. Symptoms of lupus will worsen if a sufferer smokes. Smoking directly affects the heart and blood vessels, elevating blood pressure and thus increases your risk for developing cardiovascular disease and lung infections.
- Get vaccinations. Flu and pneumonia vaccinations can help protect against infections.
Living with lupus
As with any other illness, living with and learning to cope with the condition can take its toll on a person, both mentally and emotionally. Whether having just been diagnosed, or managing the illness for years, you are likely to experience mental, physical and emotional problems (such as grief, fear, depressionand anxiety).
Emotions because of your condition have multiple causes. Visible problems (physical appearance) caused by the condition or due to treatment (medications) can have negative effects on a person’s self-esteem. These include skin problems (such as rash) or excessive weight gain.
You may also feel emotionally affected by pain, fatigue and other symptoms which may make it difficult for you to participate in things you enjoy. Pain and fatigue can wear you down and cause frustration and feelings of hopelessness. You may even isolate yourself from social activities, especially if changes to your physical appearance make you more self-conscious. Things you gain pleasure from, such as your job, sense of purpose and your income can take a knock, but often may only need to be managed more effectively.
Sometimes the mental and emotional effects of lupus are related to the disease process itself. Common mental problems include cognitive dysfunction which can lead to symptoms of depression. Depression and anxiety, mood swings and personality changes can also arise as a psychological reaction to the condition, as well as a side-effect of medicinal treatment.
Living with a chronic condition, and especially one that is unpredictable can lead to feelings of uncertainty and anxiety. Will you be able to lead an independent lifestyle? What will happen if your symptoms worsen and become debilitating? Can you manage on your own physically and financially? Can you take care of your family?
Many questions may flood your thoughts and cause you distress. It’s important to address your anxiety through a strong support system (friends, family, support groups) or medical health professional (therapist). You may find simple solutions to many of your questions, where you yourself can adapt to enable a better day-to-day quality of life. Steps you can take include educating yourself and others about your condition and its treatment, as well as practicing healthy lifestyle habits and stress-management techniques.
It can also be as simple as changing or better managing a medication you are on. Sometimes a mental health professional can help you to better identify and understand the source of your emotions, as well as provide coping tools you will benefit from.
Understanding where these problems originate can help you to develop better coping techniques for a better quality of life.