Systemic Lupus (cont.)
How can a lupus patient help prevent disease
activity (flares)?
SLE is undoubtedly
a potentially serious illness with involvement of numerous organ
systems. However, it is important to recognize that most
patients with SLE lead full, active, and healthy lives. Periodic increases
in disease activity (flares) can usually be managed by
varying medications. Since ultraviolet light can precipitate and worsen
flares, patients with systemic lupus should avoid sun exposure.
Sunscreens and clothing covering the extremities can be helpful.
Abruptly stopping medications, especially corticosteroids, can also
cause flares and should be avoided. Patients with SLE are at increased
risk of infections, especially if they are taking corticosteroids
or immunosuppressive medications. Therefore, any unexpected fever
should be reported and evaluated.
The key to successful management of SLE
is regular contact and communication with the doctor, allowing
monitoring of symptoms, disease activities, and treatment of side
effects.
How can lupus affect pregnancy or the newborn?
Patients
with SLE who become pregnant are considered "high risk." Women
with SLE who are pregnant require close observation during pregnancy, delivery,
and the postpartum period. This includes fetal monitoring
by the
obstetrician during later pregnancy. These women can have an
increased risk of miscarriages (spontaneous abortions) and can have flares
of SLE during pregnancy. The presence of phospholipid antibodies, such as cardiolipin antibodies or
lupus anticoagulant, in the
blood can identify patients at risk for miscarriages.
Cardiolipin antibodies are associated with a tendency toward blood
clotting. Patients with SLE who have cardiolipin antibodies or lupus
anticoagulant may need blood-thinning medications (aspirin with or without heparin) during
pregnancy to
prevent miscarriages. Other reported treatments include the use of
intravenous gamma globulin for selected patients with histories of
premature miscarriage and those with
low blood-clotting elements (platelets) during pregnancy. Pregnant women who have
had a previous blood-clotting event may benefit by continuation
of blood-thinning
medications throughout and after pregnancy for up to six to 12 weeks, at which time the
risk of clotting associated with pregnancy seems to diminish. Plaquenil has now been found to be safe for use to treat SLE during pregnancy.
Lupus antibodies can be transferred from the mother to the fetus and
result in lupus illness in the newborn ("neonatal lupus"). This
includes the development of low red cell (anemia) and/or white blood cell and
platelet counts, and skin rash. Problems can also develop in the
electrical system
of the baby's heart (congenital heart block). Occasionally, a
pacemaker
for the baby's heart is needed in this setting. Neonatal lupus and
congenital heart block are more common in
newborns of mothers with SLE who carry antibodies referred to as anti-Ro
(or SS-A) and anti-La (or SS-B). (It is wise for the newborn baby's doctor to be made aware if the mother is known to carry these antibodies, even prior to delivery. The risk of heart block is 2%; the risk of neonatal lupus is 5%.) Neonatal lupus usually clears after
6 months of age, as the mother's antibodies are slowly metabolized by the baby.
Next: What does the future hold for patients with lupus? »
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