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Systemic lupus erythematosis

Q: My wife is suffering from SLE (systemic lupus erythematosus) and is taking prednisolone 25 mg daily. Please suggest if there is any medicine to treat this disease completely.

A:There have been major advances in the field of systemic lupus erythematosus in the past 5 years or so. The treatment depends upon the extent and the type of organ involvement. Steroids are used only for serious complications like the kidney and/or the brain involvement. There are several additional measures that are used for the over-all management of SLE. These include protection against sun light and against premature hardening of the blood vessels (atherosclerosis) especially daily supplementation of folic acid to counter homocysteine increase in the blood that seems to be an important cause of the hardening of the blood vessels in this disease, ensuring that there is no 'thickening of the blood' (hypercoagulability) and if present, give blood thinners. Several types of anti-malarial drugs that seem to work at the root-cause of the disease, certain new hormones (DHEA, romocriptine are 2 of them) that also seem to work at the root-cause of the disease, several steroid-sparing agents that include methotrexate, azathioprine etc., physical measures like aerobic conditioning for the protection of the bones that seem to lose calcium at a faster rate thatn normal persons in this disease (besides the side effect of steroids that also cause calcium loss from the bones) along with calcium and Vitamin D supplementation. Then, there is a whole area of pregnancy and related issues in SLE that need careful discussion with the patients. I wish to repeat that, although steroids could be life-saving in some situation in SLE, one must decide very carefully about the dose, and the duration of prednisolone and clearly spell out why is it being given and the actual reason for giving it, especially when so many other drugs and measures are available.

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