Drugs Are Good Medicine! (Part II)

So far, we've covered NSAIDs and corticosteroids. These drugs are used most commonly to treat SLE and its symptoms. They are also used to treat discoid lupus, which is a form of lupus that mainly affects the skin and sometimes the joints. I plan on writing a later article covering discoid lupus and how it differs from SLE, but now, onto the next family of drugs...

Anti-malarials were originally used to (you guessed it) treat malaria. It was discovered that the prophylactic benefits of these drugs that prevented malaria attacks also worked for lupus flares. The method of how they work is unknown. The working theory is that these drugs may bind to and alter the properties of DNA. The most common anti-malarial drug used is hydroxychloroquine sulfate (Plaquenil).

Plaquenil is good for long-term use in lupus patients because it doesn't have the GI or adrenal side effects of corticosteroids. However, it does have its own particular risks. Some of these include nightmares, seizures, vertigo, dizziness, fatigue, nausea or vomiting, weight loss, hair loss, and bleaching of the hair. The more serious side effects include leukopenia (a decrease in the white cell count, which could affect a patient's ability to fight off infections), thrombocytopenia (a decrease in the patient's platelet count, which could be a life-threatening condition), ototoxicity (irreversible nerve deafness) and visual disturbances, some of which can lead to blindness. A patient who is going to be started on Plaquenil usually has to have a baseline eye examination, and then have an eye exam every six months so if any retinal changes occur, the drug can be stopped before the damage becomes severe. On a personal note, my rheumatologist has just recommended that I go on Plaquenil, so when my husband and I were discussing the possible side effects, I said "I don't mind the dizziness, and weight loss isn't really a problem for me, but I'm not pleased about the hair bleaching along with the risks for visual problems." My hubby asked, "Why not?" I replied, "Well, would you like to be known as 'The blind blonde'?" :-)

(I know, I know...But you can laugh, or you can cry. I prefer to laugh!)

The last type of drug therapy that I'm going to discuss here is the use of chemotherapy in treating lupus. This is not the first choice of treatment, but in cases where there is kidney or other major organ involvement, it may be the only thing to stop or retard the disease process.

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