Joint Pains
The Arthritis Research Campaign site suggests that people with joint pains can be treated with non-steroidal anti-inflammatory drugs (NSAIDS) although these can damage the lining of the stomach and cause bleeding. The British Medical Journal site suggests that people with joint pain should be treated with "simple analgesics" rather than NSAIDs. The newer COX-2 drugs are not associated with stomach problems but have been linked with increased risk of heart attack.
Skin Rashes.
Hydroxychloroquine is an anti-malarial drug that is also effective in reducing the rash that is a feature of lupus. It can also reduce inflammation and the swelling and stiffness of joints. Hydroxychloroquine does not work immediately, it may take 12 weeks or longer to take effect.
Side effects are not common but may include skin rashes, indigestion, diarrhoea, headaches or blurred vision. 1 in 2000 people will experience retina damage so doctors will usually check the patient's eyes before starting a course of treatment. The initial dose is 400mg but this may be reduced later as the drug starts to take effect.
Patients should not take hydroxycloroquine whilst pregnant as there is a risk of harm to the unborn child.
Heart and Lungs
If the linings of either the heart or lungs are inflamed then steroid tablets are given. Steroids are very effective but also have a number of side-effects including osteoporosis, high blod pressure and diabetes. The most commonly prescribed steroid is Prednisolone. A high dose is usually given initially to bring the inflammation under control and then gradually reduced.
Kidneys
With inflamed kidneys, severe anaemia or a very low platelet count people may need to take steroids for longer and also to take immunosuppressive drugs. These work by suppressing the body's immune system thus ensuring that it doesn't attack the body's own tissues so aggressively. However, because the body's defences are not working so well the patient will become more prone to infections.
It is important that patients have regular blood and urine tests to ensure that they are not causing other side-effects. Doctors will be keen to reduce the dosage of immuno-suppressive as soon as possible but a low dosage may be permanently required to prevent flare-ups.
Brain and Central Nervous System.
Organic brain syndromes and psychoses are managed by multidiscplinary teams with steroids, immunosuppressive drugs and anti-psychotic medication. It is not clear which immunosuppressive drug is best to deal with this kind of inflammation. Thrombotic symptoms such as strokes, transient ischaemic attacks and seizures may also require an anti-coaglation agent.
