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How can systemic lupus erythematosus be treated?

Q: My 25 years old daughter weighs 60 kg. She developed purpuras 10 months back and her platelet count fell to 18,000/mcl. It was suspected to be idiopathic thrombocytopenic purpura (ITP) and tests were prescribed. ds DNA test came positive, C-3 count was 78 and she was sensitive to sunlight. She was then diagnosed with systemic lupus erythematosus (SLE). She had taken Prednisolone (50 mg) for about eight weeks. She is taking Hydroxy Chloroquine (300 mg) per day. She has gained 10 kg of weight. Her platelet count had improved within one week after starting Prednisolone. Thereafter her reports are perfectly all right. Her ESR is below 20. How can SLE be treated?

A:System lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease that can affect various parts of the body, especially the skin, joints, blood, and kidneys. Normally, the body's immune system makes proteins (antibodies) to protect us against viruses, bacteria, and other foreign materials (antigens). In an autoimmune disease the immune system loses its ability to tell the difference between foreign antigens and its own antigens (cells and tissues) and starts making antibodies directed against body’s own proteins . These "auto-antibodies," react with the body’s tissues leading to inflammation and injury.

Management of SLE depends on disease manifestations and their severity. Periodic follow-up (every 3 months) and laboratory testing, including urine analyses, blood counts, and estimation of creatinine, are necessary to detect signs and symptoms of new organ-system involvement and to monitor the response or adverse reactions to treatment. Generally, fever, skin manifestations, musculoskeletal symptoms, and serositis represent milder disease, which may wax and wane with disease activity. These are often controlled with low-potency drugs or short steroid courses. Involvement of the brain and kidney disease are recognized as more severe disease manifestations and are often treated with more aggressive immunosuppression.

The European League against Rheumatism (EULAR) recommends that antimalarials (like chloroquine) and/or steroids may be used for treatment of SLE in patients who do not have symptoms of major organ involvement. In patients at low risk for complications from nonsteroidal anti-inflammatory drugs, these may be used judiciously for limited periods. Patients who are nonresponsive to these treatments or who cannot reduce steroids doses below those acceptable for long-term use may benefit from immunosuppressive agents such as azathioprine, mycophenolate mofetil, and methotrexate.

Chloroquine is useful in preventing and treating lupus skin rashes, constitutional symptoms and pain & inflammation in joints. It also helps to prevent lupus flares and has been associated with reduced morbidity and mortality in SLE. Corticosteroids (like prednisolone) are used predominately for anti-inflammatory activity and as immunosuppressants whenever there is acute organ-threatening exacerbation. Please be guided by your doctor who will change the treatment as appropriate.

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