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A small write up on How these medications are here to help and when monitored under a Rheumatologist, there need not be any worry. Regular check ups and follow ups is the key to a safer lifestyle.

ComorbiditiesDescription
STEROID INDUCED
Steroid induced CataractPrednisone in high doses for a prolonged time can develop side effect such as development of cataracts.
Cataracts are generally thought of as a condition of older persons. However, steroids can cause cataracts to develop in younger people.Cataract will not abate when the course of steroid treatment is complete. However, if the steroid dosage is lessened or discontinued, an existing cataract may not get any larger.Cataracts are fortunately very treatable. Not everyone who requires steroids will develop cataracts. This adverse effect of steroids is well-known, however, and anyone taking these drugs should see an eye doctor on a regular basis.Symptoms of cataracts include:
Blurry vision
Colors (especially blue) appear faded
Difficulty seeing in brightly or dimly lit rooms
Increased nearsightedness
Seeing halos around lights
Reduced night vision
Avascular necrosisCorticosteroids used on a long-term basis can cause avascular necrosis of bone and this has been seen in various diseases. This is attributable to both the disease process itself and the therapy i.e. corticosteroid usage. In rheumatology practice avascular necrosis of bone has been seen more commonly with SLEs using long-term steroids.
CostochondritisCostochondritis is the inflammation at the junction of the upper ribs . The pain of costochondritis is similar to the chest pain associated with lung disease, heart disease, gastrointestinal problem and osteoarthritis.
There is no particular test to find out costochondritis, but the doctor order some tests to rule out the above mentioned conditions.
It may go down by its own although the pain can last for few weeks. Treatment focuses on pain relief.
Steroid MyopathySteroid induced myopathy leads to muscle weakness. This is a very common side effect of chronic (a few months or more) use of steroids but can be either mild or severe. Patients usually notice weakness most in the upper legs. It is not a painful condition directly, but weak muscles and their tendons are more easily strained, which can lead to pain.
Bone Density / OsteopeniaOsteopenia is when your Bone Mineral Density (BMD) are lower than normal.Having osteopenia does increase your chances of developing osteoporosis(bones break easily).Your bone density reaches its peaks when you’re about 30 years old.
Symptoms: Osteopenia doesn’t show any symptoms. Losing bone density doesn’t cause pain.
Diagnosing test: DEXA test (results of T score [-1 to -2.5] shows osteopenia).
Causes : steroids include prednisone,prednisolone, dexamethasone and cortisone can cause osteopenia
Treatment: 1. exercise.
2. Vit D.
3. Calcium.
4. Dietary supplements.
HCQs INDUCED
HCQ toxicityHCQS, though is a wonder drug given as maintenance drug in lupus, can cause many a toxicities to the eye. Several structures of the eye can get affected.
If retina is affected, the toxic effects are seen in the macula, then it is called HCQS Maculopathy.
Early changes may be asymptomatic, but later it can cause colour vision changes.
So, it is advised to get the eye check up done in every 6 months or one year at the most to get it screened.
MigraineMigraine is severe headache felt as a throbbing pain on one side of the head. Many people also experience nausea, increased sensitivity to light or sound.
Causes of migraines are stress, skipping meals, dehydration, weather changes, certain medications, certain foods, having cold and problems with eyesight. Due to the below par quality of life, stress associated headaches are also common in lupus patients.
If your brain is affected by lupus, you may experience headaches more frequently.
Possible solutions:
firstly avoid migraine triggers , quality sleep , stress management , caffeine , magnesium intake, increasing vit B2 and yoga.
Hypercholesterolemia / DiabetesSteroids can cause several adverse effects including high cholesterol in the blood and also higher sugar level which can further lead to several complications.

Keep monitoring your diet and blood level.

FibromyalgiaFibromyalgia is a very common overlap disease with lupus, meaning that patients do, in fact, have both fibro and lupus or other rheumatologic conditions.
As mentioned, lupus presents with similar symptoms making differentiating the two all the more tricky.
a rheumatic condition characterized by muscular or musculoskeletal pain with stiffness and localized tenderness at specific points on the body.
Lupus carditisLupus can cause inflammation of the myocardium, the muscle tissue of your heart. The symptoms are chest pain and an unexplained rapid or irregular heart beat. Myocarditis is often seen when there is inflammation in other muscles in the body. However, myocarditis can be caused by viral, bacterial, and fungal infections.
Thrombocytopenia Anemia LeucocytopeniaA low platelet count is termed Thrombocytopenia. As the platelet count falls, bruising, tiny red bleeding points in the skin called petechiae (especially on the lower legs), nosebleeds, or other bleeding may occur. Although there are many possible causes of thrombocytopenia, in lupus it is almost always due to antibodies. A low platelet count may briefly be aggravated by infection. Whereas thrombocytopenia is common in lupus, only occasionally does serious bleeding result. On rare occasions, a person with lupus may have antibodies against both red blood cells and platelets.

Anemia is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood or a lowered ability of the blood to carry oxygen.When anemia comes on slowly, the symptoms are often vague and may include feeling tired, weakness, shortness of breath or a poor ability to exercise. It’s a most common blood disorder which is affecting about half of all people with active lupus.

Leukopenia is a decrease in the number of white blood cells (leukocytes) found in the blood.Low white cell count is a common in active Lupus but rarely are white cell counts low enough to lead to infection. Counts may be lowered by azathioprine, cyclophosphamide and some other drugs. Therefore, white cell counts are always monitored during treatment with these agents. If counts go too low, the prescribed drug is usually stopped briefly or the dosage is reduced. When infections occur in lupus, they are more often related to alterations in the body’s immune system that are not reflected in routine blood counts.

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a. What is lupus nephritis?

Lupus nephritis is inflammation of the kidney caused by SLE. When kidneys are inflamed, they fail to function properly and can cause protein leakage. more than 50 percentage lupus patients develop nephritis. Based on the intensity of nephritis it is further classified.

b. Body symptoms:
Urine – foamy and dark urine
High blood pressure
Increase in body weight,
Swelling – ( especially in extremities like feet, ankle, hands and eyelids)
Increased urination especially at night
blood in the urine, sometimes blood in the stool
May or may not be associated with fever

c. Diagnosing methods
Urine test – test for proteinurea, 24Hour Urine Protein
Blood test – GFR test, Creatinine
Imaging tests like ultrasound
Kidney(Renal) Biopsy

D. Treatment options
Corticosteroids
Immunosuppressants
Drugs to prevent blood clots
Drugs to maintain blood pressure

Treatment may vary from person to person based on the intensity of the disease.
If both the kidneys fail, dialysis and kidney transplant is recommended.

E. Suggested Diet
Low salt intake
Low protein intake
No Red meat
Low water intake (only if prescribed)

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Lupus cerebritis

Lupus cerebritis is a rare condition in which lupus affects the brain/Central Nervous System. Antibodies may be created in the blood which attacks the nerve cells or the blood vessels that feed them. It may sometimes interrupt the blood flow to nerves.

Body symptoms

  • Confusion, brain fog (clouded thinking), memory problems and difficulty in expressing their thoughts, depression
  • seizures (fits)
  • Headaches, dizziness, vision problems
  • Movement disorders like tremors
  • Inflammation in blood vessels of the brain and stroke can be very rare complications

Diagnosing methods

  • CT scan, MRI scan
  • Electroencephalogram (EEG) for seizures
  • Lumbar puncture for infections
  • EMG/NCS (electromyelogram/nerve conduction study) may be used to evaluate neuropathy.
  • Cognitive function test for memory impairment
  • MRA (Magnetic Resonance Angiogram) and DSA (Digital Subtraction Angiography) for CNS vasculitis

[Side effects to the drugs given for lupus can also mimic symptoms of lupus cerebritis.]

Treatment options

  • Steroids are the mainstay drugs in the treatment of lupus cerebritis. Chemotherapeutic drugs, Mycophenolate mofetil, Rituximab are also given according to the severity of the disease.
  • As the main symptom of lupus cerebritis is headache, medications to alleviate headache will be given by the doctors
  • If seizures develop, anti-epileptic medications will be given.
  • Antidepressants are given for depression symptoms.

Lifestyle changes

  • Yoga; especially pranayama
  • Meditation
  • Right Nutrition
  • Counselling and Psychotherapy
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