Medical Health Encyclopedia

Excess Bleeding from Thrombocytopenia (Drop in Blood Platelets). Treatments that may be effective for thrombocytopenia include combinations of a corticosteroid and either danazol (a male hormone) or the antimalarial hydroxychloroquine. Immunosuppressants or intravenous immunoglobulin IgG may be helpful in some patients. Surgical removal of the spleen may be advisable if bleeding disorders are a serious problem, but this option should be considered carefully, because the spleen provides one line of defense against infection. (Abnormal spleen function, in any case, appears to be fairly common in SLE.)

Kidney Disease

Drugs. Mycophenolate mofetil (CellCept), a newer drug, is proving to be helpful in treating kidney disease associated with SLE and has fewer side effects than other immunosuppressants. It is taken by mouth. Recent studies suggest that it works better than cyclophosphamide. CellCept may be best for patients with mild to moderate lupus kidney disease and may not be appropriate for patients with advanced kidney disease.

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Intravenous cyclophosphamide is the most effective drug at this time for proliferative lupus nephritis, and, in combination with a steroid, has been shown to control advanced kidney disease in between 60 - 90% of patients. It has severe side effects including nausea, vomiting, hair loss, and infertility.

Steroids are also useful for treating active kidney disease and for managing milder forms of nephritis.

Procedures. Kidney transplant or dialysis should be considered for patients with SLE with severe kidney damage. For unknown reasons, SLE does not generally recur in the transplanted kidneys. Studies are conflicting, however, over whether SLE transplant patients have higher organ-rejection rates than other kidney-transplant recipients. Both transplantation and dialysis have potentially serious complications.

Plasmapheresis. It is not clear if plasmapheresis is beneficial for SLE kidney disease.

Osteoporosis

Treatments for osteoporosis include calcium, vitamin D, bisphosphonates, parathyroid hormone, and selective estrogen-receptor modulators (SERM).

SERMs, such as tamoxifen (Nolvadex), raloxifene (Evista), and tibolone (Livial), are of particular interest in SLE because they have been designed to produce the benefits of estrogen without some of its adverse effects, such as hormone-related breast cancer.

Heart Disease

The need for aggressive treatment of high blood pressure often accompanies kidney disease. SLE is also accompanied by high cholesterol levels, which also require diet and usually drug therapies. [See In-Depth Reports #3: Angina and Coronary Artery Disease; #14: High Blood Pressure; #23: Cholesterol; #43: Heart Healthy Diet.]