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Thursday, December 5, 2013
Lupus forever or not.
Does lupus ever go away, or do you just get it under control with medicine?
The clinical course of lupus is very variable. Left untreated, it sometimes will clear up, but usually it is persistent. The severity of the disease can, however, spontaneously vary considerably from time to time. Treatment of lupus is aimed at suppressing disease, rather than curing it. Often, patients who require high doses of medications such as prednisone to get active disease under control will be able to maintain control of their disease with a much smaller dose of medication, but this needs to be worked out individually for each patient. Studies in which treatment with the drug Plaquinil (hydroxychloroquin) was stopped in patients whose disease was well controlled showed that stopping this drug in these patients was associated with an increased frequency of worsening of their lupus. Based on this finding, I believe that treatment with this drug, or with a substitute, should probably be continued even in lupus patients whose disease is well controlled. One exception to this rule is patients who developed lupus as part of a reaction to a drug (drugs such as procainamide and hydralazine can induce a lupus-like syndrome in a considerable percentage of people who take them at high dose for a long time). Lupus will slowly clear up in most of these patients once the drug is discontinued.
Fred Finkelman, MD
Director, Division of Immunology
College of Medicine
University of Cincinnati