Dr. Donald Thomas at lupusencyclopedia@gmail.com , author of The Lupus Encyclopedia presents a talk for the Maryland Lupus Summit 2013 giving tips about how to fight against lupus. His book answers "What is lupus?" as well as goes into detail about the symptoms (such as rash and arthritis) of lupus and related conditions such as fibromyalgia and Sjogren's syndrome. Go to www.facebook.com/LupusEncyclopedia , click "LIKE" to get daily tips and facts about learning to live with and fight lupus
2. • Avoid sulfa antibiotics
• Bactrim
• Septra
• Trimethaprim-sulfamethosaxole
• Add these to your allergy list
Secret 1
3. • Keep a personal record of:
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Lab results
Biopsy results
X-rays
Doctor notes
• Especially keep those that established your diagnosis of
lupus
Secret 2
4. • See a rheumatologist or other lupus expert regularly
• I recommend every 3 months at least
• Even if you feel well
• Kidney inflammation occurs in 40-60%
Secret 3
6. • Heart attacks and strokes = #1 cause of death in SLE
How important are heart
attacks and strokes in
people who have SLE?
7. • African American women with SLE develop heart attacks
and strokes 20 years younger than their peers
How important are heart
attacks and strokes in
people who have SLE?
8. • AHA 2011 Update: “Women with <SLE> .. without
clinically relevant <coronary artery disease> should be
considered at risk and screened… “
• “… women with …<coronary artery disease> … should
be screened for …< SLE>… allow the autoimmune
disease condition to be addressed.”
How important are heart
attacks and strokes in
people who have SLE?
9. • Take aspirin 81 mg a day if at increased risk for heart
attacks, strokes, blood clots
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High blood pressure
High cholesterol
Diabetes
Strong family history for heart attacks
+ Antiphospholipid antibodies
Secret 4
10. • Get 8 hours of good quality sleep per night
• Read and do everything in the sleep hygiene techniques list
• Schedule these 8 hours into every day
Secret 5
11. • Do you ever feel:
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Down in the dumps
Have problems with memory, concentration
Have severe fatigue
Trouble sleeping
Loss of interest in enjoyable activities
Pain all over
Secret 6
12. • Do you ever feel:
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Down in the dumps
Have problems with memory, concentration
Have severe fatigue
Trouble sleeping
Loss of interest in enjoyable activities
Pain all over
• Consider possibilities of:
• Fibromyalgia
• Depression
• Anxiety Disorder
• Take the self-tests for these disorders in the handout
Secret 6
13. • Do you have dryness?
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Dry eyes
Dry mouth
Itchy, dry skin in Winter
Dry vaginal area
Secret 7
14. • Do you have dryness?
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Dry eyes
Dry mouth
Itchy, dry skin in Winter
Dry vaginal area
• 30% of patients have Sjögren's Syndrome
• Especially possible if +SSA/SSB antibodies
• Go to www.sjogrens.org
Secret 7
15. • Do you have heartburn, gastroesophageal reflux disease
(GERD)?
• Abide by anti-GERD life style changes in handout
Secret 8
16. • Keep BP < 140/90
• < 130/80 if you have:
• Protein in your urine
• Had a heart attack
• Had a stroke
Secret 9
18. Is your “good” HDL level high?
Have you been told that this protects you from heart disease?
19. • Dr. Bevra Hahn (2006): 45% of patients with SLE had
proinflammatory HDL
• Increases heart attacks and strokes
Proinflammatory HDL
20. • Dr. Bevra Hahn (2006): 45% of patients with SLE had
proinflammatory HDL
• Increases heart attacks and strokes
• 2010 article: SLE patients who exercised regularly had
lower amounts of proinflammatory HDL
Proinflammatory HDL
21. • High HDL ≠ Good cholesterol in lupus
Secret 11
22. • Do not smoke cigarettes
• Keeps Plaquenil from working
• Increases lupus disease activity
• Tobacco smoke contains hydrazine
• Causes heart attacks and strokes
• Increases lung cancer
• Causes broken bones (osteoporosis)
• Call 1-800-QUIT-NOW
• www.smokefree.gov
Secret 12
23. • Exercise regularly
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Decreases heart attacks and strokes
Decrease the bad HDL that causes inflammation
Decreases fat and excess weight
Improves sleep
Improves sense of well-being
Decreases pain levels
Decreases stress
Lowers symptoms of fibromyalgia and depression
Secret 13
24. • Maintain proper weight
• Eat properly
• Exercise regularly
• Consider getting a body composition analysis by DXA
• Many lupus patients are “obese” even though their BMI is
“normal”
Secret 14
25. What is the 2nd most
common cause of death
in SLE?
27. • If you get a fever
• Most dangerous possible cause = Infection
• Call and see a doctor immediately
• Primary care physician
• Urgent care centers
• Emergency rooms
• Don’t assume it is your lupus
• Don’t assume it may be a “mild” infection that will go away
Secret 15
28. • Get the flu shot every Fall
• Centers for Disease Control Statistics:
• 20,000 – 50,000 Americans die yearly from complications of
influenza
• Most are elderly, babies, and immunosuppressed
Secret 16
29. • Get vaccines against pneumonia if you are on
immunosuppressants
• Pneumovax
• Prevnar PCV-13
Secret 17
34. • Get the Gardasil vaccine (protection from human
papilloma virus)
• Everyone 9 yo – 26 yo
• Most effective before sexual activity
• Can prevent additional infections in those who have already
been infected
• ?Use in those >26 yo?
• Sexually active
• Not in a monogamous relationship
Secret 18
35. • Keep up on cancer screening tests
• Studies show that people with lupus get less cancer
screenings
• Cancer = 4th most common cause of death
• Screening tests:
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Colonoscopy
Mammogram
Pap smear
Yearly low dose chest CT if smoker
Secret 19
36. • Take a vitamin D supplement if your level is low
• Goal level?
• At least 30 if on steroids
• Dr. Petri’s study suggests around 40
Secret 20
37. • If you take steroids (prednisone, methylprednisolone)
ask your doctor if you should be on a medicine to
prevent osteoporosis
Secret 21
38. • If you take steroids regularly, wear a medical alert
bracelet
Secret 22
39. • Take medications regularly as prescribed
• Large percentage of patients don’t take their Plaquenil
regularly
• Noncompliance = #1 reason for lupus flares and
medicines “not working”
Secret 23
40. • Carry an up to date medication list at all times
• Show it to anyone who asks you what medicines you are
taking
• Up date it every time a change is made
• Discard old medicines
Secret 24
41. • All patients should be on an anti-malarial
• Plaquenil (hydroxychloroquine)
• Chloroquine (Aralen)
• Quinacrine (Atabrine)
Secret 25
42. • Benefits of Antimalarial Medicines:
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Increase life span
Decrease internal organ involvement
Decrease risk of worsening of lupus
Decreases doses needed of steroids
Better control of severe disease when used with stronger
medicines
Decreases blood clots
Decreases neonatal lupus births
Improves chances of a successful pregnancy
Decrease the risk of diabetes
43. Hydroxychloroquine
should be put in the water
supply <of people who
have lupus>
Michelle Petri, MD, et al; Systemic Lupus Erythematosus in
A Clinician’s Pearls and Myths in Rheumatology
Photo credit = hopkinsmedicine.org
45. • Prevent eye side effects from Plaquenil
• Recommended dosing for women
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5 ½” – 5’ 6 ½” = 300 mg a day
Less than 5 ½” = 200 mg a day
Weight 102 - 135# = 300 mg a day
< 102# = 200 mg a day
• Use an Amsler grid monthly
• See eye doctor yearly after 5 years on Plaquenil
• Ask eye doctor to do:
• Visual Field 10-2 yearly
• SD-OCT or FAF or mfERG yearly
Secret 26
American Academy of Ophthalmology
52. • Use sunscreen
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Every day
Even if don’t go outside
On all exposed skin areas
Use several times a day if you go outside
Abide by UV protection measures in hand out
Secret 27
53. Joshua Krajcik and mom Lisa Pim: 2012 LFA National Butterfly Gala
Photo credit: thewashingtonlobbyist.com
54. • Avoid alfalfa and mung bean sprouts
• Contain L-canavanine
• Increases immune system activity
• Increases lupus activity
Secret 28
56. • Eat a diet rich in omega-3 fatty acids:
• Cold water fish
• Walnuts
• Flax seed
• Omega-3 fatty acids:
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Decrease inflammation
Decrease cardiovascular disease
Improves dry eyes from Sjögren's syndrome
Use diet… NOT pills
• Use more olive oil and canola oil in cooking
• Reduces amounts of bad omega-6 fatty acids
Secret 30
57. • Don’t take Echinacea
• Herb sold to reduce colds and “boost immune system”
Secret 31
58. • Consider taking DHEA
• 200 mg a day
• May help lupus by:
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Improving bone density
Improving energy
Decreasing steroid doses
Help with minor lupus problems
• Potential side effects: Acne, hair growth
• Only get from a compounding pharmacist
• Village Green Apothecary, Bethesda
• Only do after discussion with rheumatologist
Secret 32
59. • Reduce stress
• Abide by stress reduction techniques in hand out
• Learn to say “no”
Secret 33
60. • Pregnancy Secrets
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Don’t become pregnant unless cleared by rheumatologist
If SSA, SSB positive- get fetal heart monitoring regularly
See your rheumatologist and high risk OB regularly
Take aspirin 81mg a day if + antiphospholipid antibodies
(ask rheumatologist)
Secret 34
61. For most women with lupus, a
successful pregnancy is
possible.
Photo credit hopkinsmedicine.org
62. • Learn as much as you can about lupus
• Join the Lupus Foundation of America
• www.lupusdmv.org
• Join Lupus Science & Medicine
• Free internet lupus medical journal
• journals.bmj.com/site/lupus
• Click on “email alerts”
• “Like” me at facebook.com/LupusEncyclopedia
• Regular tips and Research up dates
• Follow me on Twitter @lupuscyclopedia
Secret 35
65. • Learn as much as you can about lupus
• Join the Lupus Foundation of America
• www.lupusdmv.org
• Join Lupus Science & Medicine
• Free internet lupus medical journal
• journals.bmj.com/site/lupus
• Click on “email alerts”
• “Like” me at facebook.com/LupusEncyclopedia
• Regular tips and Research up dates
• Follow me on Twitter @lupuscyclopedia
Secret 35