Lupus Disease - Signs of Lupus Symptoms

Lupus Vs Rheumatoid Arthritis: How To Tell The Difference

admin — Thu, 09 Oct 2008 05:17:32 +0000

Since they are both autoimmune disorders in which the body turns inwardly and causes harm, lupus and rheumatoid arthritis are often mistaken for the other. So, how do you differentiate between these two almost impossible to diagnose these diseases because the clinical symptoms and laboratory abnormalities tend to have in common with each other.

Both of afflict women much more frequently than men. They are also both multisystem diseases, meaning, they can affect many organs. Like lupus, rheumatoid arthritis zeroes in and causes damage to the blood vessels. Both diseases disrupt the normal function of the immune system, resulting in damaged tissues.

Lupus or systemic lupus erythematosus, is a complex disease whose cause is still undetermined. It can affect many parts of the body including joints, skin, and internal organs. Usually, the person develops a rash in the shape of a butterfly on the cheeks and across the bridge of the nose. Other symptoms include fatigue, hair loss, inflammation of the kidney, mouth sores, sensitivity to light, fever, and weight loss.

Like lupus, the cause of rheumatoid arthritis is unknown. It usually affects the wrists, fingers, knees, feet, and ankles. The disease usually begins to manifest itself with fatigue and weakness, morning stiffness that lasts for more than an hour, widespread muscle aches, and loss of appetite.

People afflicted with lupus usually feels pain in the joints, but this pain is not associated with actual damage to the join itself. In some cases, there is also swelling, but majority of lupus sufferers experience pain in the joints without swelling. In rheumatoid arthritis, however, there is always swelling of the lining of the joints. This swollen lining is called the synovium. Pain is commonly felt by patients, but it is less prominent compared to that of lupus.

One person can suffer from both lupus and rheumatoid arthritis. When rheumatoid-like symptoms are felt by lupus patients, including deformities of the joint, he or she should be given medicines for people with rheumatoid arthritis. Standard RA treatments like methotrexate,sulfalazine, and, in some cases, more potent to control joint inflammation.

Discover more about Lupus and Rheumatoid Arthritis and more Rheumatoid Arthritis Symptoms at anaudlife.com

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Causes of Fibromyalgia

admin — Wed, 24 Sep 2008 22:53:31 +0000

Although there is no exact treatment for fibromyalgia, but some preventive measures can be taken to get rid of it. Presently doctors are concentrating on managing pain, relaxing muscles and reduced depression. Doctors prescribe patients, low-stress exercises such as walking, swimming, water aerobics, and biking rather than muscle-straining exercises such as weight training. Some other measures are heat applied to sore muscles, stretching exercises (Pilates is one form.) and massage.

As there is no specific medicine for fibromyalgia, doctors try to reduce the pain and increase the sleep. In order to achieve that following types of medicines are prescribed:

Analgesics: Acetaminophen (Tylenol, others) may reduce the pain and stiffness caused by fibromyalgia. However, its effectiveness varies with individuals. Tramadol (Ultram) is a pain reliever medicine that may be taken with or without acetaminophen. Doctors often recommend nonsteroidal anti-inflammatory drugs (NSAIDs) — such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Anaprox, Aleve) — in combination with other medications, but NSAIDs haven’t proven to be useful in control the pain in fibromyalgia when taken by themselves.

Antidepressants: Doctors advise antidepressant medications, such as amitriptyline, nortriptyline (Aventyl, Pamelor) or doxepin (Sinequan) to help deep and uninterrupted sleep. Fluoxetine (Prozac) in mixture with amitriptyline has also been found efficient. Sertraline (Zoloft) and paroxetine (Paxil) are also effective for the patients suffering from depression. These medications may be beneficial by affecting serotonin levels in the brain.

Muscle relaxants: Taking the medication cyclobenzaprine (Flexeril) at bedtime may help to take care of muscle pain and spasms.

Doctors strictly oppose consumption of sleeping pills and pain killers. Patients sometimes take them for quick relief, but the effect is very short term while the side-effect lasts for a long term. These medicines are type of narcotic, so these are very harmful for the patients.

Some self made measures can also be effective to prevent fibromyalgia. These procedures can be exercised in home. The measures are:

* Proper workout include walking, swimming, biking and water aerobics. A physical therapist may help you develop a home exercise program.

* Stretching, Free-hands, Good posture and relaxation workouts are also helpful.

* Develop a plan to avoid or limit over-exertion and poignant stress. Give yourself time each day to rest.

* Exercise stress lessening techniques, such as deep-breathing exercises, meditation and Yoga.

* Leading a very healthy and simple lifestyle can also help to prevent fibromyalgia.

Abhijit Dey works on Fibromyalgia awareness and gives you the brief knowledge on Fibromyalgia. For more queries please visit Fibromyalgia

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What Is The Autoimmune Disorder Called Lupus

mod — Sat, 24 May 2008 22:14:51 +0000

This disease, called Lupus, is sometimes announced with acute arthritis and baffling symptoms very similar to many other conditions. The group of diseases known as lupus actually belongs in the autoimmune category. But what exactly is an autoimmune disorder and what is lupus? We will explore this with some more detail in this article.

Since lupus is an autoimmune disorder we must first explore what an autoimmune disease is….a rather simple explanation would be that the body’s own defense mechanism know as the immune system creates antibodies that attack it owns cells, tissue, organs etc within the body. Seemingly the immune system that is affected by lupus does not recognize its own cells and tissue because it attacks as if it were a foreign invader or germ. Now, that we have a general idea of what an autoimmune disorder is let’s look at what Lupus is.

Lupus is a disease that can seem like many other diseases. This is because the onset of the disease often has vague symptoms that are very similar to many other diseases. It seems to be a bit wishy washy as the symptoms will come and go and the symptoms vary so widely. A person can often go undiagnosed for years while the suffering person just explains away some current illness as a passing fever or something they overdid. As the disease progresses there will be periods where there are many symptoms and other times when there are little to none. The person seeming to be in perfect health. But what parts of the body are affected by this disease?

There are many parts of the body affected by the various lupus disorders. This is because the tissues that are attacked become inflamed, swollen and painful. The antibodies from the immune system can attack any tissue to include the joints, muscles, and skin. It gets worse though because the immune system also rages a war against its own nervous system and blood vessels. The other muscles and organs that can be affected are the lungs, heart, and kidneys. With so many areas of the body being attacked there will be many many symptoms. Just a few symptoms are:

•    Joint pain
•    Loss of energy or fatigue
•    Fever
•    Skin rashes
•    Weight loss or gain in a sudden manner
•    Leg and or feet swelling

These are just a few of the symptoms that can occur as a result of lupus disease. As you can see these symptoms could be attributed to many other complications too. Lupus affects every person in a different way. This is due to its ability to attack so many various parts of the body. The resulting problems can be mild or they can even be life threatening. It would be wise to visit the doctor if you experience several of these symptoms. There are different types of lupus but this article has alluded to the most common form of the disease known as systemic lupus erythematosus. The other types of lupus are:

•    Neonatal lupus is a very rare disease that unborn babies can acquire if their mom has SLE
•    Systemic lupus erythematosus or SLE as discussed in this article
•    Drug induced lupus erythematosus is induced by drugs and is not gender specific
•    Lupus nephritis which relates to inflammation of the kidneys
•    Discoid lupus erythematosus can turn into SLE and is known as a skin disorder
•    Subacute cutaneous lupus erythematosus is known by the skin lesions on patches of skin exposed to sunlight

While this autoimmune disease is incurable, the symptoms of lupus can be treated there by giving more comfort to the person suffering the many possible symptoms of this disease. A Lupus affected person who is involved in a well rounded comprehensive treatment program that supports the immune system can help to keep lupus under control and in a state of remission.

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What Are The Causes Of Lupus?

mod — Sat, 24 May 2008 22:13:47 +0000

What are the causes of the autoimmune disorder known as lupus? Well, nobody has the answer to that at this present time. There are no agents that can be pin-pointed as “the cause”. However there are many symptoms involved so the thought is that the disease is a result of many factors. What are the possible factors involved and what are the resulting symptoms? You will discover some of the information as you continue to read this article.

The overall causes of this immune dysfunction seem to fit into a couple broad categories. It is believed that genetics might be involved and environmental factors. Let look at the factors in a little more detail. Since there seems to be more than one member of a family that contracts lupus then there might be correlation between genes and lupus. Autoimmune disorders clearly are influenced by inherited genes.

Genetics and the lupus disorder run in families so you would think that something could be ascertained by this fact. But there is no single gene that has ever been identified as a gene for lupus. However there does appear to be more than one gene that can contribute to a person acquiring lupus. The possible genes that influence obtaining lupus seem to be acted upon by the environment. The environmental conditions that can trigger an onset of the condition called lupus can also aggravate an existing lupus disorder. What are some of these environmental factors?

The following are some of the factors believed to trigger lupus:
•    Viruses
•    Medication
•    Stress
•    Sunlight exposure
•    Hormones

Ok, now we will explore each of these possible triggers briefly.

Although research has been done in an effort to link viruses or bacteria as the cause of lupus there is no clear cut connection between an infectious pathogen and lupus. While there does seem to be a connection to lupus and drugs…about 400 different medications that a person could take like an antibiotics or an antidepressant.

However, the particular lupus condition associated with this drug reaction is reversible. But the condition only imitates the condition known as SLE or systemic lupus and seems to be acquired by those who are on a long term drug regime. Some of the more common medications that seem to cause the drug induced lupus are:

•    Procainamide used for treating cardiac arrhythmias
•    hydralazine used for the treatment of high blood pressure
•    quinidine used for treating cardiac arrhythmias

The good news is once a person with this form of lupus is removed from the medicine the symptoms usually go away. Not so fortunate are those that might be affected with lupus that is being triggered by stress.

Since stress can mean so many different things to a person based on their beliefs and environment we will just say that this environmental factor is whatever from of stress that disturbs that person’s balance. Stress can affect a healthy person or a person afflicted with lupus in the same ways or not all. However a person who already has lupus could have a flare up while a healthy person could have the onset of lupus triggered. Now, what about sunlight.

Well, the sun and its UV rays have been known to cause the rash associated with lupus. And UV can even alter DNA in its structure which can lead up to the creation of antibodies that are abnormal and are produced against a person’s own body tissues. Then there is the ever familiar hormones dilemma. Is it caused by hormones?

Well, women who can still have kids often are affected that is a fact. Furthermore, women who already have lupus can experience a flare up of lupus just before a menstrual cycle. But the relationship is not truly known. There is a suggestion though that because of the worsening of the lupus prior to menses and the fact that predominately females acquire SLE from of lupus that hormones do possibly play a very important role in and this area is being actively researched in the medical community.

Now that we have looked lupus a little deeper you might understand that although we are not sure of what the exact causes of lupus are there is a lot of information to help those that have already acquired lupus in some from or another. There is on going research trying to ascertain more knowledge about the autoimmune disorders and the immune system. Such as, there is research that can directly pin point an enzyme that is major player in the disposal of dead cells in our body. If the cells are not disposed of by this enzyme then this can contribute to SLE. There is much to be discovered in the realm of autoimmune disorders like lupus and the genetic system.

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What To Expect With Lupus

mod — Sat, 24 May 2008 22:12:53 +0000

With lupus there is no one part of the body that will definitely be affected or one part that will not. For starters what symptoms one has are based solely on how mild or severe the case of lupus the person has. Effects can be mild and the person may have an easy time of living with this disease. Or the effects may be severe and the person could require several aggressive medications to keep the discomforts and dangers under control. Most people live in the middle. But either way all lupus suffers will have some common discomforts.
There is more than one way that a person’s joints may cause pain. Usually it is from inflammation and swelling. This is another word for arthritis. It is one of the most common discomforts of lupus. As many as nine out of ten lupus sufferers will have some degree of arthritis. They usually suffer from it in their hands but sometimes it is in the wrists or feet. It can be worst upon rising in the morning and ease off during the day. Sometimes arthritis can be quite debilitating, but with lupus it usually does not get that serious.
The tendons can also be affected. When there is inflammation in the tendons they react by tightening. This can make the fingers, or toes, move unwillingly into odd positions. Fortunately, this is a rare affect.
As many as sixty five percent of lupus sufferers will have some kind of muscle pain. This is called myalgia. It is worst around the muscles that run between the knees and hips or one that go from the neck to the elbow. There can be inflammation of the muscles, rarely, but when there is it can be more serious than a bout of myalgia.
Everyone who knows anything about lupus is familiar with the way it affects the skin. Nearly sixty five percent of people with this disease have rashes of some kind. This can be anything from the malar or butterfly rash that is most noticeable as it runs across the cheeks and bridge of the nose or it can be hives, mouth sores or altered pigmentation. This change in pigmentation can be either patches that lighten or darken the skin. Around thirty five percent of lupus patients deal with a symptom that turns their fingers blue when they get too cold or the person is feeling overstressed. This is called Raynaud’s phenomenon,
Ten percent of lupus patients will have seizures. Thirty three percent will have positive tests that will show abnormalities in the cerebrospinal fluid. Renal failure will happen to five percent of them. Twenty percent of those with lupus will have to deal with arthropathy which though it is not destructive of the bone mass can cause deformities traced back to the disease. This disease can even cause a false result if someone is having a test for syphilis; giving a positive when there should not be one. Still despite all the things that a patient might have to deal with treatments today are able to allow those with lupus to lead fairly normal lives.

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What Is Lupus?

mod — Sat, 24 May 2008 22:11:52 +0000

Do we know what Lupus is and where it comes from? Lupus is a disease that at one time made life very difficult for anyone who contracted it. But time and technology have meant a big change to the prognosis of someone suffering from any of the three most common types of lupus and their outlook is for a near normal life once diagnosis has been made and treatment begun. The best way to describe lupus is as an ongoing infect that will attack the lungs, kidneys, skin, heart and even the blood cells. Lupus is the outcome of the immune system attacking the body instead of fighting disease. Doctors and researchers are still unable to say why this happens or why when it does it is more likely to happen to a woman. The disease gets its name from the rash that doctor’s claim looks like the face of a wolf.
Systemic lupus erythematosus, also known as SLE, is the most serious of the three. It is also the most common. It causes swollen joints that will become quite painful, rashes, tiredness, fevers and it can go so far as to cause damage to the kidneys. Sometimes a pregnant woman, who may show no signs of the disease, can pass it on to her unborn child.
The other types are called drug-induced lupus and discoid lupus erythematosus. Drug-induced lupus is caused by the use of certain medications. The person will suffer the symptoms of SLE but once the medication is stopped the symptoms will stop as well. This type of lupus almost never affects the kidneys and since it is relatively short term in duration the symptoms do not get as bad overall. Discoid lupus erythematosus shows symptoms with rashes usually coming up on the face or scalp. They can last for a matter of days or even remain for years. Once they go away they can return. Sometimes those who have suffered an attack of discoid lupus erythematosus can later develop SLE.
There are few things that health care providers are sure about with lupus. But they know that this disease can begin at any age, though more likely between fifteen and forty five, and that women are more likely to develop it than men. As well, lupus is three times as likely to occur in African American women as in Caucasian women. Though the cases are not quite as frequent it is also more common in Hispanic, Asian and Native American women. There is also a genetic disposition to it. Unfortunately, there is currently no cure. The disease is treated with a variety drugs; specifically corticosteroids and immunosuppressants, with good results. SLE usually goes through periods of illness and then remissions.
Research continues to work hard studying this disease and working hard to find a cure. Lupus cannot be caught from a person suffering from it. It also should not be mistaken for a type of cancer or a type of AIDS. It is a disease that affects nearly one and a half million people in the United States alone.

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What Happens When Lupus Is First Diagnosed?

mod — Thu, 22 May 2008 23:04:19 +0000

The patient will probably be both overwhelmed and glad to finally have a diagnosis. The newly diagnosed patient may also experience feelings of anger or sadness over knowing that they have a chronic disease. They may not know exactly what to say to family members or co-workers about their disease or what having it will mean regarding their ability to function at work, in sports or in most any activity. They will have lots of questions about their future and how lupus will affect it.

There are some tips that may help the new lupus patient to adjust to living with lupus.

1. Educate yourself, your family and friends about the disease. The more you and they understand about lupus, the more your symptoms will make sense and you can manage them better.

2. A positive attitude goes along way in any disease.

3. Find out what support systems you have at your disposal at home, work and at school.

4. Make a list of your needs and then discover ways to meet them. Do not be afraid to ask for assistance.

5. Set some goals about what you would like to do each day and decide on the best way to achieve your goals. Do not forget to ask for help from family and friends.

6. Utilize your medical team, they know a lot about lupus and can help locate resources for you. Like most diseases it is important to learn how to manage it well, so that it does not control you.

You will need to learn how to deal with the following issues:

Fatigue – this is a common element of lupus. Fatigue is a chronic state. You will feel like you may be missing out on a lot of activities because of your frequent need to rest.

You will experience joint pain and stiffness. This will have an affect on you daily, as chronic pain can be very depressing.

Be aware of physical changes that you will be noticing, like sores in your mouth or nose, drug-induced weight gain, excessive hair growth and swelling. You may also experience hair loss. These physical changes can cause you to become emotional and you will need to learn how to adjust and deal with these changes.

Your sun sensitivity will cause you to wear protective clothing and gear or miss out on a lot of outdoor activity.

Be aware that you may experience some drug side effects such as: anxiety, mood changes, depression, forgetfulness, changes in personality, and possible and psychological problems. Those who are around you may benefit from knowing about these side effects, so they will understand if you should experience them.

Depression is a common feeling when dealing with a chronic disease for the first time. It is understandable to go through a period of struggling to grasp all of the ramifications of the disease. You may feel a deep sadness. The ability to express how you are feeling can be good for you and for those around you. Keep good communication lines open between the patient and the medical team responsible for the care and well being of the lupus patient.

It is normal for family members, friends and acquaintances to be concerned for you and your future regarding home, work or school. This is the time to be honest about how you are feeling and coping with the diagnosis.

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What A Lupus Patient Needs To Know About Skincare

mod — Thu, 22 May 2008 23:03:10 +0000

It is common to experience skin problems when you have lupus. You may have lesions or ulcers in your nose or mouth. You can also have rashes that look like butterflies across your facial cheeks and your nose. It can appear faint as a blush or severe and raised and may contain some scaling. The rash will be very sensitive to sunlight and will worsen if exposed to the sun or even certain types of artificial light. The rash may be permanent or may even disappear and then reappear again.

There are three types of lesions you may encounter as a lupus patient; discoid, subacute cutaneous and mucous membrane lesions. Discoid lesions are coin-shaped and occur on the scalp region of the head. These discoid lesions do leave scars and can cause permanent balding at the site of the lesion. subacute cutaneous are red, scaly, coin-shaped lesions that are very sensitive to UV light. They appear on any large area of skin and can look like psoriasis. Mucous membrane lesions occur in the mouth, nose and even the vagina. They are also called ulcers. These ulcers or lesions are painless.

Vasculitis is a condition common in lupus patients in which blood vessels become inflamed. Very small blood vessels can become inflamed and break and cause bleeding into the surrounding tissues. This results in tiny, reddish-purple spots called: petechiae. When the spots are larger they are called: purpura. Blood clots can form, or skin ulcers or even small black areas around the nails of fingers and toes. The blackened skin is a sign of tissue damage and is a very serious condition that needs immediate medical care. Let your doctor know if you notice any black skin.

Raynaud’s phenomenon is a condition where he blood vessels of the fingers become narrowed in cold temperatures causing the fingers or toes to turn whiter (or blue) than the surrounding tissue. When the circulation returns to normal you may feel some tingling or pain. The color will return to normal, when the skin warms up again. Dress warmly in cold weather and make sure you keep your hands and feet warm. Keep your home thermostat turned up so that your home is warm. Avoid cigarette smoking, caffeine, and as much as possible avoid stress.

Tips on Caring for your Skin

1. Limit your exposure to the sun and artificial light (fluorescent/halogen bulbs).

2. Stay out of the sun during the hours of 10 a.m. and 4 p.m.

3. Apply sunscreen to any exposed areas of skin of SPF 15 or higher. Products that contain zinc oxide or titanium dioxide will block both the UVA and the UVB rays and are good to use. You should wear sunscreen all year, even on cloudy days.

4. Wear protective clothing, and hats with wide brims. Special clothing that is designed to be UV-protective can also be purchased.

Always inform your doctor if a sore or rash gets worse and always take any prescribed medicine.

If you have a mouth ulcer or lesion, rinse your mouth with salt water and eat soft foods until it heals. Your doctor may recommend a treatment or medicine to apply to the ulcer.

Avoid using anything on your skin that may make your skin condition worse like: hair dyes, skin creams, even some drugs can make your skin more sensitive to the sun (talk with your doctor about this). If you must wear makeup, be sure to use the hypoallergenic ones. If available use products that state they have UV protection.

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Treatment Beginnings For Lupus

mod — Thu, 22 May 2008 23:02:10 +0000

Treatment aims for lupus are completely dependent upon the degree of the illness the patient is suffering with. The biggest concern is organ damage. This must be avoided at all costs and so greatly influences the method of treatment. Preventing kidney damage is one of the issues that must be dealt with. The trouble is that people suffering from lupus develop such an array of other issues to deal with that these must all be considered not just the treatment of the disease itself. Lupus can lead to osteoporosis, hardening of the arteries or potential blood clots.
There are medications that can help with all the conditions related to lupus. Aspirin, in minimal doses, is sometimes given to help reduce the pain and inflammation of swollen joints. Anti-malaria medications are often given to help ease the inflammation. They are also able to protect the skin of the person with lupus from the rashes that they get when out in the sun.
The patient with lupus may find the number of physicians they must see a little daunting. Likely they will have begun their investigation by going to see their health care provider. They may then be sent to see the immunologist. This is the doctor who specializes in diseases of the immune system. After that the patient might see a rheumatologist if the swelling of their joints, which is just another way of saying arthritis, is a problem for them. But this is not the only professionals that it will be suggested that the lupus sufferer will see. They may need a dermatologist, a skin doctor, to help with the rashes, nephrologists to check them over if there is a concern about kidney damage or a hematologist to treat conditions related to the blood. The patient may require a neurologist should there be problems affecting the central nervous system. During their many medical appointments they will deal with many nurses who will be working to assist them in whatever way they can, technicians who will take care of the testing process and possibly a psychologist to help with their emotional state.
Once the diagnosis has been made the health care provider will sit down with their patient and work out where to start with what kind of treatment. The patient will be very involved in guiding the plan. Treatment for this disease has come a very long way since it was first discovered and written about in the early 1800s. Until the disease was better understood people could die from the effects as it damaged the organs seriously. There is no longer this drastic an outlook for those who have this disease. If caught early and the patient follows treatment protocols than the likelihood is for a normal lifespan, even if it means taking medication for the rest of their lives. Also important to keeping the patient with lupus healthy is eating right, getting some exercise without overdoing it, sleeping enough and trying to do things to allow a healthy and happy life.

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Treating Lupus with Immunosuppressive Drugs

mod — Thu, 24 Apr 2008 19:24:14 +0000

The job of immunosuppressive medication is to lessen the action of the body‘s immune system. These drugs are normally used during organ transplant surgery to ensure that the recipients do not reject the organ being transplanted. Once a person has had a transplant they will have to be on these immunosuppressive drugs for the rest of their lives. Researchers hope this will change but right now this is the only safe way to follow-up with organ transplants. These drugs have another purpose that is equally as important. For those who have lupus of any kind these drugs are very necessary especially if the symptoms they are suffering from show that the kidneys or the central nervous system are becoming damaged.
Despite the fact that these drugs can have side effects they have many benefits. One big one is that they are often a replacement for the corticosteroids that are steroid based and much more difficult for the body to tolerate. Nonetheless if it is corticosteroids that a lupus patient needs they should use them. But, if instead they can use the immunosuppressive drugs this is highly preferable. As well, when the patient is done using the immunosuppressive medication they will see that the side effects will go away and many will reverse after the medication is stopped.
There are several immunosuppressives that are more widely used in the United States. They include azathioprine, cyclosporine, cyclophosphamide and methotrexate. They can be given in pill form or if the health care provider feels the need to use a more aggressive form of fighting the disease then it is possible to administer the drug intravenously.
It is not recommended that women who are in the middle of a treatment plan using immunosuppressives get pregnant while taking the medication. These drugs are very strong and so definitely can put the baby at risk. It is suggested that during a treatment period women use birth control methods and continue them for at least twelve weeks after the treatment is over. Some of these drugs can also come through breast milk so it is important to get a clear idea of the options from the health care provider who is treating their lupus condition.
Before a doctor starts their patient on immunosuppressives there are a few things to make sure of. It is necessary to be certain the patient will not have an allergic reaction to the medication. They must get an updated medical history to check that and the condition of the patient before they begin the drug treatment. They must also learn what damage has been done to the person’s organs and only then make the decision to put them on this medication. This is done the usual way; by blood work, x-rays and other imaging technology as well as liver and kidney function testing.
Despite the fact that when the health care provider is about to suggest a treatment like this there is likely no other choice it is a good idea to explain to the patient why they are suggesting this medication and what the likely outcome and side effects are.

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