Lupus treatment often requires many medications

Dear Doctor: My daughter got a rash across her cheeks that we thought was an allergy. A year later, she was diagnosed with lupus. She’s only 17, and the doctors keep putting her on different meds, which worries her dad and me. I’ve been reading that ginger can be helpful. What do you think?

Dear Reader: Lupus is what is known as a chronic autoimmune disease. That means it’s a long-term condition in which the immune system, which isn’t behaving properly, has begun to attack the body’s own tissues. There are several forms of the disease, but the most common is systemic lupus, which can affect the joints, skin and certain internal organs, including the heart and kidneys.

Although anyone can develop the disease, about 90% of people with a form of lupus are female. It usually appears between the ages of 15 and 44, which are a woman’s reproductive years. Genetics plays a part, and people who have a family member with lupus, or another kind of autoimmune disease, are at higher risk of developing it. It’s also more common in people of African American, Native American, Asian, Latino and Hispanic descent.

The rash that you noticed on your daughter’s face is one of the classic signs of a flare, or episode, of systemic lupus. Known as a butterfly rash, it looks somewhat like a localized sunburn that affects the upper cheeks and spreads across the bridge of the nose. Additional symptoms can include fatigue; swelling, pain or stiffness in the joints; chest pain; dry eyes; and other types of rashes.

Treatment consists of managing symptoms, which, as you have discovered, can require a number of medications. They address issues such as blood clots, inflammation, immune system response, fluid retention, infections and high blood pressure. Each case of lupus is different, with different levels of severity and varying symptoms. As a result, a shifting range of medications can be required. This can be daunting, and even alarming, and we encourage you to discuss your concerns with your daughter’s rheumatologist.

Elizabeth Ko, MD and Eve Glazier, MD

As to your question about ginger, there’s an interesting new study led by researchers from the University of Michigan. When they looked into the effects of 6-gingerol, the main bioactive compound in ginger, they found evidence it inhibited a specific mechanism associated with abnormal clot formation. Mice that were given 6-gingerol had lower levels of sticky, weblike proteins known as neutrophil extracellular traps, or NETs. These play an important role in immune function. In autoimmune diseases, however, NETs become overactive. After giving the mice 6-gingerol, the researchers noted that the formation of blood clots was markedly reduced.

While this research is exciting, and even encouraging, it’s only an early step in a long process. More research is needed in animal models, and then, if that continues to be promising, with humans. In the meantime, your daughter should continue to make regular visits to her rheumatologist and use the medications prescribed. Her doctors will monitor her disease and recommend the treatment protocols that her specific type of lupus requires.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)


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