believe it is safe to
“wait and see”—to avoid intervention and allow the body to correct itself without medical assistance—they probably will do so. If the patient’s symptoms, even temporary ones, are sufficiently severe to make “wait and see” too miserable to endure, they will still first choose the mildest of treatments, the one with the least side effects.
Only if matters become serious do they go in with the big guns. This is why we have discussed NSAIDs first for the treatment of lupus.
Although not side-effect free, they are well known and compara-tively mild. The other drugs in the lupus pharmacy have more serious potential side effects, but balancing this risk, they are generally more effective.
Antimalarial Drugs Are Antilupus
The first group of drugs found to be helpful in lupus was originally designed to attack the malaria parasite, a great example of the serendipity that occasionally blesses the “let’s-see-if-this-will-have-any-effect” approach. The oldest antimalarial drug, quinine, was tried experimentally in lupus as early as the 1890s (see “Lupus in History,” in Chapter 2), and related drugs were used successfully in 65
POL text Q6 good.qxp 8/12/2006 7:39 PM Page 66
6 6
Po s i t i v e O pt i o n s fo r L i v i n g w i t h L u p u s the 1920s to heal the skin lesions associated with discoid lupus.
Several quinine derivatives are still prescribed today, particularly hydroxychloroquine (Plaquenil), chloroquine (Aralen), and quinacrine (Atabrine). Of the three, hydroxychloroquine is most commonly prescribed because it has the lowest side-effect profile.
Treating malaria in its active phase involves reducing fever, so perhaps it is not surprising that antimalarials do this for lupus sufferers too. But they also help with skin lesions, joint inflammation, and fatigue. Characteristically for a serendipitous discovery, there is no clear explanation as to why they should have this effect. They are immunosuppressive. (A study done in Africa showed that antimalarials used conventionally to treat active malaria reduced the response to vaccination, when in fact a protective immune response is the desired effect.) They are also antiviral and anti-inflammatory, though via what mechanism is unclear, possibly by suppressing the production of prostaglandins (as do NSAIDs) or those chemical messengers of inflammation, the cytokines (see Chapter 5). They have two other clearly beneficial actions: They are sun-blocking—
valuable to lupus sufferers who are so often hypersensitive to light—and they lower cholesterol, one of the soluble fats transported in the bloodstream that contribute to cardiovascular disease and the production of blood clots. This is good news for people with lupus, who often have clotting problems, especially during pregnancy, and good news for everyone else too.
. . . and Now the Bad News
There are of course side effects with antimalarials. There is a small risk of the usual upset stomach (about one patient in five), ringing in the ears (tinnitus), and occasionally headaches, but the major concern is damage to the retina of the eye.
When hydroxychloroquine is first prescribed it is usually given in quite high doses—up to 400 milligrams (mg) a day—and it can cause temporary visual problems: blurred vision or a “halo effect”
around lights. This is reversed once the dose is reduced. Finding the POL text Q6 good.qxp 8/12/2006 7:39 PM Page 67
Tre a t i n g L u p u s w i t h D r u g s , Pa r t 2
6 7
optimal dose for an antimalarial is quite difficult because the drug does not become effective for at least two weeks, sometimes longer, so this initial side effect can be decisive in determining whether the drug can be used on any given patient. Graham Hughes employs a
“juggling” drug regimen with antimalarials if a patient has severe skin complications. If 400 mg of hydroxychloroquine daily causes vision problems, he reduces the dose by using a different
“wait and see”—to avoid intervention and allow the body to correct itself without medical assistance—they probably will do so. If the patient’s symptoms, even temporary ones, are sufficiently severe to make “wait and see” too miserable to endure, they will still first choose the mildest of treatments, the one with the least side effects.
Only if matters become serious do they go in with the big guns. This is why we have discussed NSAIDs first for the treatment of lupus.
Although not side-effect free, they are well known and compara-tively mild. The other drugs in the lupus pharmacy have more serious potential side effects, but balancing this risk, they are generally more effective.
Antimalarial Drugs Are Antilupus
The first group of drugs found to be helpful in lupus was originally designed to attack the malaria parasite, a great example of the serendipity that occasionally blesses the “let’s-see-if-this-will-have-any-effect” approach. The oldest antimalarial drug, quinine, was tried experimentally in lupus as early as the 1890s (see “Lupus in History,” in Chapter 2), and related drugs were used successfully in 65
POL text Q6 good.qxp 8/12/2006 7:39 PM Page 66
6 6
Po s i t i v e O pt i o n s fo r L i v i n g w i t h L u p u s the 1920s to heal the skin lesions associated with discoid lupus.
Several quinine derivatives are still prescribed today, particularly hydroxychloroquine (Plaquenil), chloroquine (Aralen), and quinacrine (Atabrine). Of the three, hydroxychloroquine is most commonly prescribed because it has the lowest side-effect profile.
Treating malaria in its active phase involves reducing fever, so perhaps it is not surprising that antimalarials do this for lupus sufferers too. But they also help with skin lesions, joint inflammation, and fatigue. Characteristically for a serendipitous discovery, there is no clear explanation as to why they should have this effect. They are immunosuppressive. (A study done in Africa showed that antimalarials used conventionally to treat active malaria reduced the response to vaccination, when in fact a protective immune response is the desired effect.) They are also antiviral and anti-inflammatory, though via what mechanism is unclear, possibly by suppressing the production of prostaglandins (as do NSAIDs) or those chemical messengers of inflammation, the cytokines (see Chapter 5). They have two other clearly beneficial actions: They are sun-blocking—
valuable to lupus sufferers who are so often hypersensitive to light—and they lower cholesterol, one of the soluble fats transported in the bloodstream that contribute to cardiovascular disease and the production of blood clots. This is good news for people with lupus, who often have clotting problems, especially during pregnancy, and good news for everyone else too.
. . . and Now the Bad News
There are of course side effects with antimalarials. There is a small risk of the usual upset stomach (about one patient in five), ringing in the ears (tinnitus), and occasionally headaches, but the major concern is damage to the retina of the eye.
When hydroxychloroquine is first prescribed it is usually given in quite high doses—up to 400 milligrams (mg) a day—and it can cause temporary visual problems: blurred vision or a “halo effect”
around lights. This is reversed once the dose is reduced. Finding the POL text Q6 good.qxp 8/12/2006 7:39 PM Page 67
Tre a t i n g L u p u s w i t h D r u g s , Pa r t 2
6 7
optimal dose for an antimalarial is quite difficult because the drug does not become effective for at least two weeks, sometimes longer, so this initial side effect can be decisive in determining whether the drug can be used on any given patient. Graham Hughes employs a
“juggling” drug regimen with antimalarials if a patient has severe skin complications. If 400 mg of hydroxychloroquine daily causes vision problems, he reduces the dose by using a different
Similar Books
