NEWER MEDICAL TREATMENTS
- Thalidomide
This previously shunned drug has been found to be
useful in lupus, specifically for the treatment
of ankylosing spondylitis, a related rheumatic
syndrome.
Research has shown that thalidomide suppresses an
important inflammatory agent known as TNF-alpha.
There have been a number of studies to show that
it is particularly effective in chronic discoid
lupus with severe skin problems.
A large percentage of patients respond to the
therapy, but once it is discontinued, the
symptoms reappear fairly rapidly.
This, together with some severe side effects
including a reversible peripheral neuropathy and
teratogenic effects, make it much less
attractive.
It should only be used as a last resort.
- Prestara
Prestara appears to be well tolerated.
Adverse events were reported in both the placebo
and the treatment group during trials. Adverse
events associated with Prestara were generally
mild and expected and included acne, facial hair
growth, and hormonal changes, which are typical
androgenic hormones side effects.
In patients receiving Prestara, there was a
statistically significant decrease in
high-density lipoprotein (HDL) cholesterol.
On the other hand, there was also a statistically
significant reduction in triglycerides, a lipid
that in high levels may increase risk of heart
disease.
Underscoring the serious nature of lupus, there
were five deaths, including two suicides, among
patients in the study.
All of the deaths were in the placebo group.
The findings confirmed the tolerability of
Prestara in patients with lupus.
- Kiel Synchronization Protocol
This procedure, developed by a German clinic, is
a variation on the NIH (National Institutes of
Health) protocol for the treatment of severe SLE.
The NIH protocol uses Cytoxan (an
immunosuppressant chemotherapy drug) and
cortisone on a frequent and long-term basis.
In contrast, the Kiel protocol uses smaller and
less frequent doses of the same powerful drugs,
but combines them with a blood filtration
technique called plasmaphoresis, which removes
undesirable proteins and antibodies.
This is reported to have achieved a long-term,
treatment-free remission in 64% of their 28
patients.
The Kiel protocol reports are promising and
warrant further scrutiny.
- Collagen
Research in rheumatoid arthritis pointed to the
potential of using oral collagen (a protein that
is a major component of joints and skin) to
signal the body to reduce inflammation.
PLASMAPHERESIS
Plasmapheresis removes antibodies from the circulation,
producing short-term clinical improvements.
This is done by a procedure that usually entails five
exchange treatments of 3 to 4 liters each, carried out
over a two-week period.
The effects are rapid; improvements occur within days of
treatment.
Improvement correlates roughly with reduction in the
antibody titers. Unfortunately, effects are temporary,
lasting only weeks.
For those rare cases that other methods of treatment do
not work, plasmapheresis can be used as a long-term
therapy.
Some negative aspects of the plasmapherisis process are
problems with venous access, risk of infection of the
indwelling catheter, hypotension, and pulmonary embolism.
Stem Cell Therapy
Stem cell therapy can be considered as a technology that
works by replacing diseased or dysfunctional cells with
healthy, functioning ones.
The therapeutic treatment harvests the beneficial
characteristics of adult stem cells.
Stem cells, also known as progenitor cells, are primitive
cells that give rise to other types of cells.
Through the isolation and targeted manipulation of cells,
scientists are researching for ways to identify young,
regenerating ones that can be used to replace damaged or
dead ones in diseased organs.
This therapy is similar to the process of organ
transplant, but in this case, it's the transplantation of
cells rather than organs.
These new techniques are being applied to a wide range of
human diseases, including lupus, when all other therapies
and treatment interventions have failed.
IMMUNO-SUPPRESSIVE Therapies
These treatments typically are used in organ-threatening
cases when steroids have failed or are not tolerated by
the patient. In truth, these regimens are forms of
chemotherapy (also referred to as cytotoxic therapy) and
may involve some of the same drugs used in treating
cancer. As such, they offer the same powerful positive
and negative consequences of most chemotherapy. As with
steroids, immunosuppressants, because of their toxicity,
should be utilized only when other treatments are
ineffective. The most common drugs used are cytoxan and
methotrexate
STEROID THERAPY ** AND SIDE EFFECTS
Despite their negative consequences, steroids are a
critical intervention for lupus, particularly when the
disease threatens an organ.
Steroids are hormones that have a number of functions in
the body, including the stabilization of inflammatory
cells and the decrease of the white blood cells
responsible for immunologic memory.
Many lupus patients have no choice in the
use of steroid therapy: they must take these drugs or
they will develop catastrophic organ involvement.
Some side effects of steroids may be mitigated with the
proper supplements.
The most significant example is the loss of calcium
leading to osteoporosis.
Proper nutritional treatment of osteoporosis involves a
delicate balance of minerals, far beyond simply taking
calcium.
Additionally, steroids may cause potassium levels to
decrease.
When this occurs, oral replacement is required.
Because steroids can release clots of fat into the blood
stream, nutritional supplements which break down fats are
recommended.
Another possible result of steroid therapy is cognitive
confusion and loss of concentration.
If this occurs, there are many supplements available.
Finally, steroids may deplete vitamin B6, vitamin D, and
zinc.
These substances require supplementation. B-complex
vitamins also are depleted by aspirin and indomethacin,
common anti-inflammatory medications.
ANTI-MALARIALS
This class of drugs is remarkable for its effectiveness,
safety, and multiple benefits. However, antimalarials are
not useful in organ-threatening SLE and they take months
to reach their full effectiveness.
These medications, most often Plaquenil, may be used in
combination with other treatments or in some mild cases
may be the only drug required as it helps greatly with
joint involvement and skin issues.
The antimalarials decrease inflammation which helps with
joint pains, protect the skin from ultraviolet light
damage, inhibit blood clotting, provide energy, block
cytokines (which promote inflammation), and, as a bonus,
lower cholesterol.
In addition, the antimalarial hydroxychloroquine appears
to protect against osteoporosis in corticosteroid treated
patients with SLE.
Aside from a possible rare side effect of retinal
toxicity in the eyes which can be monitored easily with
seeing an opthamologist regularly, and therefore
prevented, Plaquenil has no major drawbacks other than
possible gastrointestinal intolerance.
Choice of medication is important because some other
antimalarials (chloroquine) may cause irreversible eye
damage whereas the damage which may be caused by
plaquenil can be reversed if caught in early stages.
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