Frequently asked questions into Lupus

Lupus is not hereditary. Thus, the presence of antibodies should not be studied in the newborn child. Women with lupus and carriers of the anti-Ro antigen can have a baby with neonatal lupus as they pass these antibodies to the baby. In any case, this situation is temporary given that the antibodies are eliminated in about 6 months.

There are various recommendations to follow, such as protecting yourself from the sun, avoiding the use of UVA ray machines, stopping smoking, and stopping taking a drug that may have triggered the lupus.

The prognosis for CLE is very variable and difficult to predict individually. However, it can be said that in many patients, after an initial phase of activity in which the lesions emerge and are difficult to control, it enters a much less active phase. Finally, the lesions may begin to disappear or appear occasionally and in a mild form. For this reason, it is important to always protect yourself from the sun’s rays and avoid smoking.

El tratamiento del LEC puede ser de 2 tipos (que pueden combinarse entre sí en algunos casos): tópico y sistémico. En cuanto al tratamiento tópico, que es con el que se suele tratar a la mayoría de pacientes con lupus eritematoso cutáneo (LEC) sin lupus eritematoso sistémico (LES) pueden tratarse con corticoides; inhibidores de la calcineurina; corticoides intralesionales; maquillajes (útiles para disimular las cicatrices y secuelas). Respecto a los tratamientos sistémicos existen los antipalúdicos o los inmunodepresores, principalmente.

Los antimaláricos (hidroxicloroquina y sulfato de cloroquina) se pueden tomar durante el embarazo y, de hecho, es recomendable no suspenderlos antes, ya que se ha relacionado con un aumento del riesgo de brote durante la gestación. El uso de dosis altas de corticoides se ha relacionado con alguna complicación como diabetes gestacional, rotura prematura de membranas o prematuridad. Sin embargo, dosis bajas son seguras. Los inmunosupresores que están contraindicados durante el embarazo por su potencial efecto de riesgo de malformaciones fetales (teratogénico) son la ciclofosfamida, metotrexato y micofenolato. La azatioprina se puede administrar durante la gestación. La aspirina y la heparina, tratamiento que se administran en algunas pacientes con anticuerpos antifosfolipídicos se consideran seguros durante la gestación. En cuanto a belimumab y rituximab, por falta de datos en mujeres embarazadas, se recomienda que no se administren si la paciente se quiere quedar embarazada.

Por la relación entre los estrógenos y la actividad del lupus y las trombosis, los anticonceptivos orales combinados (estrógenos y progestágenos) no se pueden recomendar en las pacientes con actividad moderada-grave de la enfermedad o en aquellas con anticuerpos antifosfolipídicos que se relacionan con el desarrollo de trombosis.

Exposure to the sun can be a cause of reactivation of the lupus and make the symptoms worse. Thus, it is advisable to avoid exposure to ultraviolet (UV), UVA and UVB rays (solar or artificial) both directly and indirectly (swimming pool or sea water, sand, snow, UVA devices, fluorescent tubes), mainly in those patients whose symptoms clearly worsen with these. These patients must apply a sun protection cream to exposed parts, and wear suitable clothes (caps with a peak, and long sleeves). Sun filters (protection factor greater than 30) should be applied approximately one hour before any possible solar exposure and again after a bath or sweating. Don’t forget that the sun’s rays are also present on cloudy days.

It depends on the severity of the disease. Some people change their working conditions or even reduce their working day, while other continue working full-time. Sometimes, sick leave is needed and, if the lupus is very active, some patients apply for disability.

The fact that lupus can produce very varied symptoms (fever, arthritis, muscle pains, tiredness, etc.), causes a feeling of uncertainty and anxiety in many patients with this disease, which leads them to consult with their specialist due to the minimum discomfort they note. Although it is obvious, a patient with lupus will have, throughout their lives, trivial processes that will be cured in the same way as applied to the rest of the population. However, any abnormal situation that lasts more than 2 or 3 days must be mentioned to the health professional that normally looks after the patient.