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| Dr. Winsome Beverley Christie President of the Pharmaceutical Society of Jamaica |
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| Brittney Taylor Assistant Secretary of the Pharmaceutical Society of Jamaica |
In recent years, SLE has been on radar as that autoimmune
disease that is seen on the rise amongst both sexes of all ethnic groups. Interestingly,
approximately ninety percent (90%) of SLE cases are seen in women. Of all the
ethnic groups the rates appear to be higher inblack women. (Danchenko et al.,2006).
An ethnic diverse study conducted in Michigan, concluded
that the prevalence of SLE was 10-fold higher in females, with a 1 in 537 approximationsin
black females. (Somers et al., 2014) Although, the prevalence appears to be
higher in black women, the rates vary for black women living in different areas
of the world.For example, reports from an early study done solely on black
people in West Africa, proved the prevalence of SLE to be rare however, the
ratesin said women living in America,
the Caribbean and Europe was relatively high (Symmons DP, 1995).
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| Kevar Bennett Secretary of the Pharmaceutical Society of Jamaica. |
SLE AND
COVID
Several autoimmune rheumatic diseases such as
systemic lupus erythematosus (SLE) result from immune-mediated inflammation and
tissue damage caused by immune system dysregulation. As a result, patients with
autoimmune rheumatic disease have been identified as a vulnerable population at
risk for severe COVID-19 illness. Although a strong antiviral immune response
is needed for viral clearance, hyperactive immunity has been linked to cytokine
storm and tissue damage in COVID-19 patients . Both SLE and COVID-19 have been
shown to manifest multi-organ complications of interstitial pneumonia,
cytopenia, arthralgia, myocarditis, and hemophagocytic lymphohistiocytosis .
Due to similarities in disease characteristics, treatment of patients with SLE
may provide insights into development of therapeutic options for COVID-19.
Lupus treatment
The treatment modalities will focused on two types of
lupus: Discoid lupus and Systemic Lupus Erythematosus.
Discoid lupus is a
skin problem that causes raised red areas (called "plaques") and
scars on the skin. Discoid lupus can happen anywhere on the skin but usually
happens on the upper body. The most common places for discoid lupus are the
face, neck, scalp, and ears.
Symptoms of
discoid lupus: red, scaly plaques.
These plaques tend to slowly expand at the edges and then heal. When they heal,
they leave behind discolored skin and sunken scars. Discoid lupus on the scalp
can cause hair loss.
Sometimes, people with discoid lupus also have lupus in
other parts of the body. This is called "systemic lupus." But most
people with discoid lupus just have lupus in their skin.
Treatment involves mainly topical applications but can
include corticosteroids and medication similar to those used for the more
generalized systemic lupus erythematosus.
- Steroid medicines that come in ointments, creams, or gels – These steroid medicines reduce inflammation and help the skin heal. Examples include fluocinonide or clobetasol.
- Medicines called calcineurin inhibitors that come in ointments or creams. Examples include pimecrolimus (brand name: Elidel) and tacrolimus (brand name: Protopic).
- Steroid medicines that come as injections, are given locally into the portion of skin that is affected.
Sytemic lupus erythematosus treatment depends on symptoms and how the person is feeling. The goals of treatment include:
- Ease your symptoms
- Bring down inflammation
- Prevent and relieve flares
- Prevent organ damage and other
health problems
Pain
and inflammation associated can be treated with non-prescription drugs such as
- Acetaminophen
- Aspirin
- Ibuprofen
- Naproxen
Antimalarial drugs Pain Antimalarial Drugs such as
hydroxychloroquine" or
"chloroquine
They might help with skin rashes, mouth sores, and joint pain. They may also lower your
chance of blood clots, which is a concern in some people with lupus.
Antimalarial drugs protect against skin damage from ultraviolet rays in sunlight and may
protect your body against organ damage linked to lupus.
These can be a pill form or IV, they work
fast to ease swelling, warmth, and soreness in joints that’s caused by
inflammation. They can also prevent long-term organ damage.
Corticosteroids can have serious side effects
like:
- Higher chance of infections
- Fragile bones or bone damage,
especially in your hips
- Muscle weakness
- Diabetes
- Cataracts
You may also have weight gain, bloating, and mood changes. Your doctor will probably give you
the lowest dose they can and taper it off if your symptoms go away for a time.
Immunosuppressive drugs
Like corticosteroids, these drugs curb your
immune system, bring symptoms under control, and help prevent long-term organ
damage. Your doctor may prescribe them if corticosteroids haven’t helped your
symptoms.
Common immunosuppressive drugs for lupus
include:
- Azathioprine (Imuran)
- Cyclophosphamide (Cytoxan)
- Methotrexate (Rheumatrex)
In some cases, you may use immunosuppressive
drugs along with corticosteroids. That way, you'll be taking a lower amount of
each type of drug, reducing the possible side effects.
With both types of drugs, you and your doctor
need to weigh the risks of side effects against how well they ease your lupus symptoms.
Immunosuppressive can make it hard for your
body to fight infections and raise your chances for some kinds of cancer. One particular immunosuppressive drug azathioprine may
cause pancreatitis or a form of hepatitis. Cyclophosphamide may lead to bladder
problems, hair loss, or fertility problems. Methotrexate can cause nausea,
headaches, mouth sores, sun sensitivity, lung infections, and liver damage.
- Anticoagulants. These
thin your blood to
prevent clots, a life-threatening lupus symptom.
- Monoclonal
antibodies. Belimumab (Benlysta) is the
first drug created just to treat lupus. Given intravenously (in a vein) or
subcutaneously (under your skin), it targets specific immune cells. It may
help reduce your need for steroid treatment, but it hasn’t been tested
thoroughly for the most severe forms of lupus. Rituxan (Rituximab)
is another monoclonal antibody that can sometimes treat lupus when other
treatments haven’t worked.
- Repository
corticotropin injection. A medicine called H.P.
Acthar Gel may help your body make its own steroid hormones like cortisol
to fight inflammation.
Side effects of other medications
Common side effects of anticoagulants include
bloating, diarrhea, upset stomach, vomiting, and loss of appetite. You may
rarely have bruising, a skin rash, a sore throat, back pain, or yellow skin and
eyes (jaundice).
Monoclonal antibodies might cause problems
like headache, nausea, hives, or blood pressure changes. These can usually go
away over time.
Acthar Gel may cause swelling, changes in
blood pressure or glucose tolerance, mood changes, stronger appetite, or weight
gain.
Complementary treatments for Lupus can be
supportive and aimed at reducing stress, improving the immune system and
reducing inflammation and pain. They may include:
- Acupuncture
- Biofeedback
- Massage
- Meditation
- Chiropractic treatments
- Herbs and other supplements
Talk to your doctor or pharmacist before
trying any alternative or complementary treatments for lupus. Also ask your
pharmacist to run a drug interaction on their “system” to see if there are any
potential or real interactions.
Lifestyle Changes
A healthy lifestyle will help you feel better
and prevent flares. It can also help prevent problems linked to lupus,
like kidney disease, heart attack, and stroke.
Try these tips:
- Eat a well-balanced
diet.
- Quit
smoking (or don't start) to protect
your heart and blood vessels.
- Get plenty of rest to ease fatigue,
a common lupus symptom.
- Exercise most
days to help sleep,
mood, and heart health.
- Always use sunscreen when
you go out.
- Get pneumonia and flu
vaccines to protect against
infections.
- Staying out of the sun in the middle of the day (from 10 AM to 4 PM), when the sun's light is strongest
- Stay under a sun umbrella, tree, or other shady spot
- Wear sunscreen – Put sunscreen on all parts of the body that are not covered by clothes. Then reapply sunscreen every 2 to 3 hours, or after you sweat or swim. It's important to choose a sunscreen that:
- Has an SPF of 30 or greater – SPF is a number that tells you how well a sunscreen protects the skin from UV light.
- Protects against 2 types of UV light, called "UVA" and "UVB." (Sunscreens that offer both UVA and UVB protection are sometimes called "broad spectrum.")
- Has not expired or is not more than 3 years old
- Wear a wide-brimmed hat, long-sleeved shirt, and long pants
- Do not use tanning beds
- If you smoke, it's a good idea to quit. Discoid lupus seems to be more severe in people who smoke. Also, smoking seems to make certain medicines for discoid lupus less effective.
If you are bothered by the way discoid lupus looks on your skin, you can use special cosmetic products to make the skin changes less obvious.
- Dr. Winsome Beverley Christie, President of the Pharmaceutical Society of Jamaica,
- Kevar Bennett, Secretary of the Pharmaceutical Society of Jamaica.
- Brittney Taylor Assistant Secretary of the Pharmaceutical Society of Jamaica,
References
Bae SC, Fraser P, Liang M. The epidemiology of systemic lupus
erythematosus in populations of African Ancestry. Arthritis & Rheumatism 1998; 41:2091-2099
Danchenko N , Satia JA, Anthony MS. Epidemiology of
systemic lupus erythematosus: a comparison of worldwide disease burden. Lupus 2006; 15:308-18
Lewis MJ, Jawad AS. The effect of ethnicity and genetic ancestry on
epidemiology, clinical features and outcome of systemic lupus erythematosus. Rheumatology 2017; 56:67-77
Somers EC, Marder W, Cagnoli P et al. Population-based incidence and
prevalence of systemic lupus erythematosus: the Michigan Lupus Epidemiology and
Surveillance program. Arthritis Rheumatol
2014; 66:369-78
Symmons DP. Frequency of lupus in people of African origin. Lupus 1995; 4:176-8
Discoid Lupus
Lupus Treatment
Complementary and Alternative (CAM)
Treatments of Lupus-LUPUS UK
Lupus Treatment: Medications and Alternative Treatments (webmd.com)
Guan W, Ni Z, Hu Y, Liang W, Ou
C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in
China. New Engl J Med (2020) 382:1708–20.
doi: 10.1056/NEJMoa2002032
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