Positive Options for Living with Lupus by Philippa Pigache Page A
Authors: Philippa Pigache
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antimalarial (quinacrine) on alternating days. (Quinacrine, also known as mepacrine, is not a first-choice antimalarial because it has its own vision side effects and can also produce slight yellowing of the skin and eye whites.)
The more serious vision side effect of antimalarials was seen more frequently in the past when high doses were used with less caution. It takes the form of pigment deposits in the retina—the area at the back of the eye where images are formed and relayed to the brain. This condition is called macular retinopathy and if allowed to continue undetected can lead to blindness. For this reason most hospitals keep a close watch on patients who are taking the drug.
They are advised to protect their eyes from strong light of all sorts and at all times, and to wear high-quality sunglasses, indoors as well as out, especially if they may be exposed to fluorescent or halogen lighting. In addition the eyes should be examined regularly by a qualified ophthalmologist. The frequency of such examinations can be as little as every few months, but not less than once a year.
If these precautions are observed there is evidence that antimalarials may be taken for months, or even years, and that in addition they may protect against lupus flare-ups.
Douglas’ Story
Douglas developed lupus in middle age. A t first he attributed the arthritic symptoms to wear and tear; it was only when the distinctive discoid rash appear ed on his scalp that his doct or realized it was lupus. Hydroxychloroquine was prescribed, and after a few weeks the symptoms cleared up. But when the medication was stopped, the symptoms returned. Douglas went back on the antimalarial, this time f or months. It was only when he POL text Q6 good.qxp 8/12/2006 7:39 PM Page 68
6 8
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 had his routine eye test nearly a y ear later that the ophthalmic optician discovered that there was damage to the retina. Douglas had noticed nothing unusual; as f ar as he was concerned his sight was normal. His doct or changed the medication, v ery apologetic that he had not insisted on Douglas’ having an ophthalmic checkup sooner. Subsequent eye exams showed that the damage was not progressing. Douglas was lucky; sometimes the sight continues to deteriorate even when the drug is stopped.
In the past, antimalarials were always discontinued during pregnancy because of the risk that they might affect the developing fetus. However, an increasing number of studies now suggest that successful pregnancies can be completed by women who are taking hydroxychloroquine, though some obstetricians still prefer to err on the side of caution.
Corticosteroids
Does the hair stand up on the back of your neck at the mention of these drugs? Once highly thought of, they have acquired a bad reputation. When the first drug— cortisone— was launched in the 1940s it demonstrated such dramatic reductions in inflammation that it was hailed as a wonder drug, a “cure” for rheumatoid arthritis and lupus, and earned its discoverers, Philip Hench and Edward Kendall, a Nobel Prize.
But in the wake of the rave reviews for the miracle cure came serious side effects (mostly because the drugs were being used in very high doses at the time): weight gain, increased blood pressure, easy bruising and slow healing, cataracts, muscular weakness, elevated blood sugar causing problems with diabetes, less resistance to infection because the immune system was being suppressed, and, with long-term use, thinning of the bones (osteoporosis). Corticosteroids were no longer the flavor of the month.
Corticosteroids are, in fact, laboratory versions of hormones occurring naturally in the body. Human steroids are produced mostly by the adrenal glands, but also by the testicles and ovaries. They POL text Q6 good.qxp 8/12/2006 7:39 PM Page 69
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 9
help control metabolism (how the body generates
The more serious vision side effect of antimalarials was seen more frequently in the past when high doses were used with less caution. It takes the form of pigment deposits in the retina—the area at the back of the eye where images are formed and relayed to the brain. This condition is called macular retinopathy and if allowed to continue undetected can lead to blindness. For this reason most hospitals keep a close watch on patients who are taking the drug.
They are advised to protect their eyes from strong light of all sorts and at all times, and to wear high-quality sunglasses, indoors as well as out, especially if they may be exposed to fluorescent or halogen lighting. In addition the eyes should be examined regularly by a qualified ophthalmologist. The frequency of such examinations can be as little as every few months, but not less than once a year.
If these precautions are observed there is evidence that antimalarials may be taken for months, or even years, and that in addition they may protect against lupus flare-ups.
Douglas’ Story
Douglas developed lupus in middle age. A t first he attributed the arthritic symptoms to wear and tear; it was only when the distinctive discoid rash appear ed on his scalp that his doct or realized it was lupus. Hydroxychloroquine was prescribed, and after a few weeks the symptoms cleared up. But when the medication was stopped, the symptoms returned. Douglas went back on the antimalarial, this time f or months. It was only when he POL text Q6 good.qxp 8/12/2006 7:39 PM Page 68
6 8
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 had his routine eye test nearly a y ear later that the ophthalmic optician discovered that there was damage to the retina. Douglas had noticed nothing unusual; as f ar as he was concerned his sight was normal. His doct or changed the medication, v ery apologetic that he had not insisted on Douglas’ having an ophthalmic checkup sooner. Subsequent eye exams showed that the damage was not progressing. Douglas was lucky; sometimes the sight continues to deteriorate even when the drug is stopped.
In the past, antimalarials were always discontinued during pregnancy because of the risk that they might affect the developing fetus. However, an increasing number of studies now suggest that successful pregnancies can be completed by women who are taking hydroxychloroquine, though some obstetricians still prefer to err on the side of caution.
Corticosteroids
Does the hair stand up on the back of your neck at the mention of these drugs? Once highly thought of, they have acquired a bad reputation. When the first drug— cortisone— was launched in the 1940s it demonstrated such dramatic reductions in inflammation that it was hailed as a wonder drug, a “cure” for rheumatoid arthritis and lupus, and earned its discoverers, Philip Hench and Edward Kendall, a Nobel Prize.
But in the wake of the rave reviews for the miracle cure came serious side effects (mostly because the drugs were being used in very high doses at the time): weight gain, increased blood pressure, easy bruising and slow healing, cataracts, muscular weakness, elevated blood sugar causing problems with diabetes, less resistance to infection because the immune system was being suppressed, and, with long-term use, thinning of the bones (osteoporosis). Corticosteroids were no longer the flavor of the month.
Corticosteroids are, in fact, laboratory versions of hormones occurring naturally in the body. Human steroids are produced mostly by the adrenal glands, but also by the testicles and ovaries. They POL text Q6 good.qxp 8/12/2006 7:39 PM Page 69
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 9
help control metabolism (how the body generates
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