Preventive measures are necessary to minimize the risks of steroid-induced osteoporosis and accelerated atherosclerotic disease. [146] The American College of Rheumatology (ACR) Guidelines for the prevention of glucocorticoid-induced osteoporosis suggest the use of traditional measures (eg, calcium, vitamin D) and the consideration of prophylactic bisphosphonate therapy.
Along with nutritional deficiencies, steroid medications can cause significant weight gain and increased cholesterol, blood glucose, and triglycerides, further underscoring the need for patients with SLE who are taking these agents to follow a healthy diet to counter the effects.6 There are also specific things that individuals with SLE should avoid, including alfalfa sprouts and garlic, which can stimulate an already overactive immune system.7 
A large randomized trial that compared induction therapy consisting of oral mycophenolate mofetil with cyclophosphamide therapy in patients with lupus nephritis showed that mycophenolate mofetil was not inferior to cyclophosphamide. [132] The investigators suggested that mycophenolate mofetil was associated with both a trend toward greater complete remissions and a greater safety profile. [132] This study’s findings were confirmed with the large, international Aspreva Lupus Management Study (ALMS) trial. [133]
The ACR Quality of Care statement [147] recommends annual cardiovascular disease risk assessment; some researchers suggest that the cardiovascular risk for SLE is similar to that for diabetes mellitus. The 10-year coronary event rate is 13-15% in patients with active SLE, which is comparable to the 10-year event rate of 18.8% in patients with known coronary artery disease. [148] African American patients with SLE may be particularly vulnerable to premature cardiovascular disease and related death. [149]

While the onset and persistence of SLE can show disparities between genders, socioeconomic status also plays a major role. Women with SLE and of lower socioeconomic status have been shown to have higher depression scores, higher body mass index, and more restricted access to medical care than women of higher socioeconomic statuses with the illness. People with SLE had more self-reported anxiety and depression scores if they were from a lower socioeconomic status.[99]


From the time we are kiddos, we are told that we should exercise and eat right in order to grow up big and strong, right?  Well instead, we spent many-a-weeknight-dinners pushing around the peas and other veggies lying ominously on our plates, in the hopes that they will magically disappear, or hiding them under the mashed potatoes to make it look so. Then, making those stink faces at our parents, when we hear that we are having fish for dinner (unless, of course, its the breaded and fried unidentifiable kind.)  As we grew, many of us -but not all of us- have had taste buds and/or common sense that grew and matured simultaneously with our bodies. We have since learned to like, perhaps even love our veggies and those little fishies we once abhorred. For others… not so much. Back to top
Other sets of criteria, known as disease activity indices, exist for the monitoring of lupus. These forms allow a physician examining a patient to check for the improvement or worsening of the disease. These forms include the BILAG (British Isles Lupus Assessment Group Index), SLEDAI (Systemic Lupus Erythematosus Disease Activity Index), SLAM (Systemic Lupus Activity Measure), ECLAM (European Consensus Lupus Activity Measurement), and the Lupus Activity Index (LAI). Sometimes these indices will show no signs of lupus, even when the patient feels badly. This is because some of the problems that occur in lupus, such as chronic fatigue and pain, are not tracked by the indices. Instead, these symptoms represent a co-occuring problem called fibromyalgia.
Levels of stress-related illnesses are on the rise, and stress, both emotional and physical, has been shown to trigger and intensify autoimmune disorders. Stress is your body’s response to a threat–a wound, injury, or infection. Acute stress revs up your immune system to help you deal with an immediate crisis, and then calms it back down once the threat is removed. On the other hand, chronic stress (the kind we face in this day and age) leads to long-term inflammation and actually suppresses your immune system. This can trigger or worsen autoimmune conditions, and can lead to the reactivation of latent viruses linked to lupus, perpetuating a vicious cycle.
Recent research has found an association between certain people with lupus (especially those with lupus nephritis) and an impairment in degrading neutrophil extracellular traps (NETs). These were due to DNAse1 inhibiting factors, or NET protecting factors in people's serum, rather than abnormalities in the DNAse1 itself.[65] DNAse1 mutations in lupus have so far only been found in some Japanese cohorts.[66]
Photosensitive systemic lupus erythematosus (SLE) rashes typically occur on the face or extremities, which are sun-exposed regions. Although the interphalangeal spaces are affected, the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are spared. Photo courtesy of Dr. Erik Stratman, Marshfield Clinic.
The lupus erythematosus (LE) cell test was commonly used for diagnosis, but it is no longer used because the LE cells are only found in 50–75% of SLE cases, and they are also found in some people with rheumatoid arthritis, scleroderma, and drug sensitivities. Because of this, the LE cell test is now performed only rarely and is mostly of historical significance.[72]
Next, a doctor will usually prescribe a corticosteroid such as prednisone, which has a variety of unpleasant and dangerous side effects. Long term prednisone therapy can cause muscle wasting and osteoporosis, and those side effects require additional monitoring and medication. If the steroids stop controlling the symptoms, then a host of other serious medications are prescribed that either modulate or suppress the immune system as a whole. Plaquenil and belimumab (Benlysta) are some of the drugs used, and they have very harsh side effects including hair loss, muscle atrophy, blood disorders and increased susceptibility to infections.
Drug-induced lupus erythematosus is a (generally) reversible condition that usually occurs in people being treated for a long-term illness. Drug-induced lupus mimics SLE. However, symptoms of drug-induced lupus generally disappear once the medication that triggered the episode is stopped. More than 38 medications can cause this condition, the most common of which are procainamide, isoniazid, hydralazine, quinidine, and phenytoin.[54][10]
When lupus starts affecting other organs of the body, doctors often prescribe drugs that suppress the immune system, says Kramer. (Lupus causes the body’s immune system to mistakenly attack itself. Immunosuppressive medications help stop that from happening.) One such example, is Cytoxan (cyclophosphamide), originally an anticancer drug. It suppresses the immune system and may be used to reduce inflammation of the kidney, or nephritis, says Dr. Kaplan.

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