Lupus, Part 2 — Treatment, side-effects, restrictions, and implications for school
Treatment
Laboratory tests can help diagnose lupus and determine which, if any,
organs are involved. Regular blood and urine testing is useful in monitoring
the activity and severity of the disease, as well as how well the medications
are tolerated. Typical laboratory tests include ANA, anti-DNA, other antibody
tests, CBC, ESR or CRP, complements, urine tests, and other tests specific
to involvement in different organs of the body.
The medications prescribed are selected for specific reasons. If the
lupus causes only arthritis and rash the medications can be relatively
mild, such as nonsteroidal anti-inflammatory drugs (NSAIDs; ex Naprosyn,
Ibuprofen, or Celebrex). Disease modifying anti-inflammatory drugs (DMARDs)
may also be used. A mild one that helps rash and fatigue especially is
Plaquenil. Methotrexate is a DMARD that can be given orally or by injection
and requires regular laboratory monitoring. More powerful DMARDs called
cytotoxic drugs include Imuran and Cytoxan and can be taken by mouth or
by injection or infusion. These are reserved for children with severe
lupus involvement. One of the more effective drugs for controlling lupus
is a steroid or glucocorticoid called Prednisone. The more severe the
disease the higher the steroid dose and the more severe the side effects.
Steroids are generally tapered as quickly as possible.
Possible medication side-effects
NSAIDs may cause side effects such as abdominal pain and should be taken
after meals, easy bruising, and rarely headaches. Many children on Plaquenil
require eye exams once or twice a year but new guidelines have reduced
the need for regular eye exams on this medication. Methotrexate and the
other stronger DMARDs require regular monitoring. Students on glucocorticoids
may have weight gain, mood swings, loss of bone mass, and occasional concentration
problems in school.
Physical/dietary/other restrictions
Since lupus is affected by the sun students should stay out of the sun
and use sunscreen and wear a hat if they are outside in the sun. A healthy
diet is important to help manage the disease. Students on glucocorticoids
should limit salt intake and monitor the amount of food they eat to avoid
excessive weight gain.
Implications for school
Fatigue is usually severe initially and students may miss school for
doctor appointments or hospitalizations. It is helpful to limit the amount
of make up work after an absence or hospitalization so that the student
can get back to school without the stress of trying to keep up and also
catch up on missed work. A tutor or homebound teacher, to assist in catching
up assignments, is indicated after a lengthy absence. When their lupus
is active many students nap after school or go to bed very early and so
limited homework is helpful, especially in high school when they may have
several teachers scheduling projects on the same deadline. PE may be a
problem if the student has joint pain or swelling and they should be allowed
to self-limit an activity that causes more pain. As the lupus is better
controlled, most students resume regular activities and have no limitations.
The symptoms of lupus may come and go but consistently taking medication
is the most important way to reduce disease flares. Lupus can be a life
threatening disease and the medical treatment plan needs to be followed
to ensure a good outcome.
Lupus, Part 2 — Treatment, side-effects, restrictions, and implications for school
For more information, please contact:
Kathy Davis, MSEd, PhD
kdavis2@kumc.edu
(913) 588-6305