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Live Longer and Better With Lupus
Donald Thomas, MD, FACP, FACR
Italy 959 AD
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Hebernus Hildricus
Éracle
Liège Belgium
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The bishop of Liège, Hildricus by name … an honest and moral man… by a secret judgement of God, pitiably Or rather extraordinarily, troubled with a disease that is popularly called lupus
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It was a misery to behold him, so severely was the strength of the illness raging, consuming, devouring the man’s flesh, though feeding on the outside, Was more intimately Consuming his internal matter.
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Life Magazine, June 6, 1949
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Francis Page: Quinacrine Trial, 1950
Francis Page: Quinacrine Trial, 1950
17/18 discoid lupus cleared
1 systemic lupus improved
2 rheumatoid arthritis improved
Francis Page: Quinacrine Trial, 1950
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Drugs Approved and Drugs Used to Treat SLE
BENLYSTA
Benefits of antimalarials
•↑ life span
Benefits of antimalarials
• ↑ life span
•↓ steroid doses
Benefits of antimalarials
• ↑ life span
• ↓ steroid doses
•↓ internal organ disease
Benefits of antimalarials
• ↑ life span
• ↓ steroid doses
• ↓ internal organ disease
•↓ diabetes
•↓ cholesterol
•↓ blood clots
Benefits of antimalarials
• ↑ life span
• ↓ steroid doses
• ↓ internal organ disease
• ↓ diabetes
• ↓ cholesterol
• ↓ blood clots
•↓ infections
Benefits of antimalarials
• ↑ life span
• ↓ steroid doses
• ↓ internal organ disease
• ↓ diabetes
• ↓ cholesterol
• ↓ blood clots
• ↓ infections
•↑ energy
Benefits of antimalarials
• ↑ life span
• ↓ steroid doses
• ↓ internal organ disease
• ↓ diabetes
• ↓ cholesterol
• ↓ blood clots
• ↓ infections
•↑ birth rates
Benefits of antimalarials
• ↑ life span
• ↓ steroid doses
• ↓ internal organ disease
• ↓ diabetes
• ↓ cholesterol
• ↓ blood clots
• ↓ infections
•↑ REMISSION
Problem
•50%
Problem
•50% of
patients take their
Plaquenil
Koneru S et al. Adherence to
medications in systemic lupus
erythematosus. JCR.2008;14(4):195
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Virus
↓ Vitamin
D
↓ Vitamin
D
↓ Vitamin
D
46
Michelle Petri, MD
“What happens in lupus when
we improve vitamin D levels?”
Petri M, et al. Vitamin D
In systemic lupus;
A&R;7/13;65(7):1865
48
Incandescent Compact fluorescent LED
Highest UV No UV
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Sulfa antibiotics
Stress
Stress
↓ Vitamin
D
The
Lupus
Secrets
Causes of Death in Lupus
Causes of Death in Lupus
• 1st – Heart attacks, strokes, blood clots
Causes of Death in Lupus
• 1st – Heart attacks, strokes, blood clots
•2nd – Infections
Causes of Death in Lupus
• 1st – Heart attacks, strokes, blood clots
• 2nd – Infections
•3rd – Severe lupus organ disease
Causes of Death in Lupus
• 1st – Heart attacks, strokes, blood clots
• 2nd – Infections
• 3rd – Severe lupus organ disease
•4th - Cancer
Prevent Infections
•Vaccines
Prevent Infections • Vaccines
–Flu shots
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Prevent Infections • Vaccines
– Flu shots
–Pneumonia shots
Pneumovax
Prevnar
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Prevent Infections
• Vaccines
– Flu shots
– Pneumonia shots
–Shingles shot
(Zostavax) www.escholarship.org
65 Curtis J et al, EULAR abstract 2014
Incidence of shingles per 1000 – person years
66 Curtis J et al, EULAR abstract 2014
Incidence of shingles per 1000 – person years
67 Curtis J et al, EULAR abstract 2014
Incidence of shingles per 1000 – person years
Prevent Infections •Vaccines
– Flu shots
– Pneumonia shots
– Shingles shot (Zostavax)
–Gardasil if < 27 yo
Prevent Infections
• Vaccines
•Fever → See Doc ASAP
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Prevent Infections • Vaccines
• Fever → See Doc ASAP
•Don’t smoke
Prevent Infections • Vaccines
• Fever → See Doc ASAP
• Don’t smoke
•Safest Lupus Treatments
– Vitamin D
– Ultraviolet light protection
– Plaquenil (hydroxychloroquine)
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The Lupus “Secrets”