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Managing Lupus

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Dear Dr. Levister: Since being diagnosed with Lupus my life has been hell. Are there ways to manage this disease? L.W.

Dear L.W.: Part of managing lupus is preventing flares, times when the disease gets worse. During a flare, a person with lupus may feel much more tired, sick, feverish, and achy than usual. Almost all lupus patients take medication to control inflammation and reduce the risk of flares.

Lupus is a rheumatic (having to do with the muscles, joints, and connective tissue) condition that affects 1.5 million people in the United States, including an estimated 10,000 children.

Nearly 90% of those diagnosed with lupus are female.

There is no known cure for lupus, but the symptoms of the disease can be controlled. Often a patient with lupus has a health care team that includes specialists who can help treat the symptoms. That team may include a rheumatologist (a doctor who specializes in conditions of the joints and connective tissues), a nephrologist (a doctor who specializes in kidney diseases), an advanced practice nurse, a social worker, and other consulting doctors, like a dermatologist, psychologist, or infectious diseases specialist.

Doctors frequently prescribe corticosteroids, which are drugs that are used to control inflammation. These aren't the same steroids some athletes take. If a doctor prescribes one of these medications, the dosage and any side effects will be carefully monitored.

For day-to-day muscle and joint pain, patients can take acetaminophen or any of a variety of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen. Others take antimalarial drugs (medicines first developed to prevent and treat malaria, but that have also been found to help treat lupus). Antimalarial drugs often help treat skin rashes and joint pain.

Some children with kidney disease may require more aggressive treatment with immunosuppressive drugs, which lower the body's immune system responses. Although the cause of lupus is unknown, researchers think that many factors may trigger the disease.

Genetics may play a role. Some people may have a genetic predisposition to lupus that is then activated by an infection, certain medications, or extreme physical or emotional stress. The hormone estrogen may also play a role in lupus and could help explain why it is more common in females than males. Lupus also occurs more frequently in African Americans, Asian Americans, Latinos, and Native Americans than in caucasians.

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