Lupus and You: Signs, Symptoms, Medications and Outcomes

From the Bronx Stop on the 2013 Hospital Tour

What are some of the effects of lupus on the body? What medications are used to treat lupus? What is the connection between lupus and osteoporosis? These are just a few of the questions answered by two lupus specialists who spoke to patients and their family and friends at Montefiore Medical Center as part of the S.L.E. Lupus Foundation’s annual Hospital Tour.

Here are highlights of their presentations for those who could not attend.

Lupus and You: Your Body, Your Medications
Onome Whiteru, MD

Dr. Whiteru’s presentation reviewed the various manifestations of lupus and discussed the medications used to treat lupus. Following are key learnings from her talk:

  • Lupus affects the body in many ways but it can be controlled with treatments and go into remission.
  • Medications used to treat lupus protect your body from the harmful effects of lupus but can also cause side effects.
  • Treatments for lupus usually include some combination of steroids, nonsteroidal anti-inflammatory drugs (NSAIDS), antimalarials, cytotoxics, and biologics.
  • Steroids are used for many manifestations of lupus; they are anti-inflammatory and suppress the immune system.
  • They can have many side effects and close monitoring by your healthcare professional is important.
  • NSAIDS (nonsteroidal anti-inflammatory drugs) include aspirin, ibuprofen, and naproxen and are mostly used for pain relief.
  • Antimalarials
    • Hydroxychloroquine (Plaquenil) is usually well tolerated and can help reduce the risk of a flare.
  • Cytotoxics
    • Azathioprine (Imuran or Azasan) is typically used to treat moderate to severe manifestations of lupus.
    • Methotrexate (Rheumatrex or Trexall) is typically used to treat the arthritis component of lupus.
    • Mycophenolate mofetil (Cellcept) is typically used for lupus kidney disease as well as refractory cytopenias and vasculitis.
    • Cyclophosphamide (Cytoxan) is typically used for the most severe manifestation of lupus: lupus kidney disease, lupus of the nervous system, severe vasculitis and severe refractory anemias.
  • Biologics
    • Belimumab (Benlysta) is usually used to help patients get off steroids and is particularly effective for the skin and arthritis manifestations of lupus.
    • Other ways to protect yourself are to use sunscreen, make sure you are getting enough calcium, vitamin D and folate, and get vaccinated. 

Onome Whiteru, MD attended the Sophie Davis School of Biomedical Education at the City College of New York and completed her medical school and internal medicine residency training at SUNY Downstate Medical Center in Brooklyn, New York. She was a Clinical Assistant Professor of Medicine at SUNY Downstate and is currently a rheumatology fellow at the Albert Einstein College of Medicine.

Bone Health and Lupus
Cindy Johnston, MD

Dr. Johnston’s presentation covered the link between lupus and osteoporosis and discussed methods of prevention and management. Following are key learnings from her talk:

The Link Between Lupus and Osteoporosis

  • Studies have found an increase in bone loss and fracture in individuals with SLE.
  • Women with lupus may be nearly five times more likely than those without the disease to experience a fracture from osteoporosis.
  • Individuals with lupus are at increased risk for osteoporosis due to
    • glucocorticoid medications that can trigger significant bone loss
    • pain and fatigue caused by the disease that can result in inactivity, further increasing osteoporosis risk
    • bone loss in lupus that may occur as a direct result of the disease.
  • Decreased physical activity is just one of many risk factors for osteoporosis and the pain and fatigue of lupus can make it difficult to be physically active, adding to the risk for osteoporosis.
  • Low Vitamin D level is another risk factor and since some people with lupus avoid sunlight since it can trigger flares, this may be one reason why some people with lupus have low Vitamin D levels.

Osteoporosis Prevention and Management

  • Even though your genes mostly determine how strong your skeleton will become, your lifestyle also plays a big part in your bone health.
  • Ways to prevent and treat osteoporosis in people with lupus are not very different from those for people without lupus.
    • Bone density screening
    • Diet and supplements: calcium and vitamin D
    • Fall prevention
    • Lifestyle modification
    • Don't smoke
    • Avoid excessive alcohol
    • Exercise

Cindy Johnston, MD is the Chief Fellow of the Division of Rheumatology at Albert Einstein College of Medicine. She graduated from Rutgers University and completed medical school and residency training in Internal Medicine at Robert Wood Johnson Hospital in New Brunswick, NJ.  Her interests are rheumatoid arthritis (RA), lupus, and osteoporosis. 

For more information -

Learn more about medications used to treat lupus from these webinars, in English and Spanish.

You can find more information on lupus and osteoporosis here.

Next Stops on the 2013 Lupus Hospital Tour:

May 7 at Harlem Hospital Center, Manhattan:

"Skin Care, Weight Control and Feeling Good with Lupus" with Amanda Sammut, MD and Sharon Isaac, MS, CDN (Nutritionist)

May 16 at New York Methodist Hospital, Brooklyn

"Lupus and the Effect of Medication" with Mona Pervil, MD & “The NYC Poison Control Center: A Resource for Questions About your Medicines” with Luz Martinez

All programs are from 6pm to 8pm, include dinner, and are free. RSVP is required.

Register online or call 212-685-4118 or email jrowshandel@lupusny.org and provide your name, phone number, and the number of people attending.