Azathioprine can cause abnormal liver function tests but rarely causes liver failure in lupus patients, especially if the drug is stopped when abnormal tests are seen. The effects of azathioprine are reversible. Other things to consider though are: could any other drugs have caused the abnormality, is there anything to suggest a viral infection causing the abnormality and could the blood test abnormality be due to lupus (but this is a rare manifestation of lupus)? There are other drugs that can be used but which is best depends on the patient and the answers to the above questions. And it would be best to wait and check that the liver tests have returned to normal before starting a new drug or changing another drug dose except for steroids which could be increased if the lupus is active.

These test results also occur in Sjogren's syndrome, which is like a sister disease to lupus. They are both autoimmune diseases associated with antibodies. Sjogren's is typically associated with dry eyes and dry mouth, often with salivary gland swelling under the chin or in front of the ears - early in the disease. It is milder than lupus when it occurs as the initial disorder (primary Sjogren's syndrome) but it can occur as a secondary condition in someone with lupus, later in life, and also can occur secondary
to other conditions such as rheumatoid arthritis.

NO, complete hair loss is very unusual. Steroids work very quickly within a few days but Plaquenil takes up to 3 months to have an effect (which is why you need both). The problem with hair loss is that once it is weakened at the hair root, it will be at risk of falling out and it may take several months for new stronger hair to regrow. So the hair loss will continue even after the drugs start working to prevent new hair damage.

You should go through the risks with your specialist in more detail. In principle, most people do very well with this drug and it is used by over 40% of lupus patients at some point in their disease. It is safer than using higher doses of prednisolone (steroid) than you would otherwise need. There is no safer drug if you can't take Plaquenil and it is more effective,  although there are more possible side-effects and there is a need for regular blood tests to avoid complications.

Your daughter needs to see her doctor and to have blood tests done. Imuran takes up to 3 months to work so she is not likely to have had much benefit yet and a flare of lupus is certainly possible. A side-effect of Imuran is also possible, probably less likely, but it is not possible to be certain either way without a full assessment. Blood tests should be done 1 or 2 weeks after starting Imuran so this is urgent if a full blood count has not yet been done.

It has been conventional to use Imuran (azathioprine) in this situation for many years. Cellcept (mycophenolate mofetil) is a much newer drug which is beginning to be used in lupus . However there is still not a lot of evidence as clinical trials in lupus are on-going, comparing it to azathioprine and cyclophosphamide in terms of benefit and side-effects. It may be more effective than azathioprine (more like cyclophosphamide but with less side-effects) but is a great deal more expensive and in many places it can only be used if someone has not responded to azathioprine and/or cyclophosphamide, or cannot take them for some reason. As her kidneys have improved there does not appear to be any need to consider cellcept at this time, but it is always important to talk the options over with the doctor involved, who will have available to them all the clinical and laboratory details about the case.

These are episodes of acute pericarditis and may continue to occur intermittently. Chronic pericarditis is rarer and as the name suggests is a chronic or persistent i.e. long-term continuous problem. Most people with acute pericarditis do not go on to get chronic pericarditis but it is possible.The drug treatment should help to prevent further flare ups but the doses are lower than average although this may be appropriate to your weight. This should be discussed with your specialist.

Yes, but this type of kidney disease does not always progress to renal failure, and if it does it may take a long time e.g. 10-20 years. With modern treatment it may go away completely. Sometimes it changes into another type of kidney disease with time and if so, it is more likely to cause long-term problems if not properly treated. 

Suggested questions: What treatment is planned? What are the possible side-effects and how can they be reduced/avoided? How likely is it that this treatment will work and get rid of the kidney disease? How long will it take (i.e. how long on initial treatment and then what will happen - usually therapy reduced and continued for several years)? What happens if the initial treatment does not work? (If not treated the disease certainly will progress to renal failure requiring dialysis or transplantation eventually and there may be a risk of other complications of active Lupus such as high blood pressure, so any risks from the treatment must be balanced against the risks of not treating the Lupus disease...)

Yes!

It varies. Steroids, anti-histamines, anti-malarials and dapsone have all been used. You will need to talk to your Lupus specialist and/or a dermatologist (skin specialist). Your GP may prescribe other anti-histamines if this has not already been tried but they don't always work. Sulphonamide allergy is fairly common in Lupus and it would be best to avoid such drugs in future as the antibiotic may have triggered this flare.

I would NOT recommend an oestrogen containing (combined) pill unless anti-phospholipid antibodies, as measured by the anti-cardiolipin antibody AND "lupus anticoagulant" tests, have been done and are both negative. I would have the tests repeated 3-6 months after starting the combined pill if it is taken. Low platelets can be the first sign of anti-phospholipid syndrome (sticky blood) which causes blood clots (thrombosis). As the oestrogen containing (combined) pill can also increase the risk of blood clots (thrombosis), this form of contraception can be very dangerous in people with anti-phospholipid antibodies, as measured by the anti-cardiolipin antibody OR lupus anticoagulant tests.
 

The progesterone only pill ("Mini-pill") can be taken, as can Depo-Provera progesterone injections, by people with anti-phospholipid antibodies who need contraception. All forms of contraception can have side-effects and these should be discussed with your doctor.

Unfortunately there are no pills or medicines that will stop the sun affecting you although the rate at which Lupus patients are affected can vary from day-to-day, week-to-week. It is important that you use a good sunblock every day (a little goes a long way, the 'white face-look' is totally unnecessary) and it is wise to wear a hat and long sleeves/trousers when in the sun. There is no reason why Lupus patients shouldn't enjoy any good weather we may have in the UK or go abroad to hotter climates provided 'precautions' are taken. It really isn't advisable to sit out all day in the sun for anyone regardless of whether they have Lupus or not.

Enjoy good days but don't forget your sunblock and cover up exposed areas
when the sun is bright.

For the past 7 months I have been on 50mg of Imuran. My symptoms have been relieved considerably, however I have not gone into complete remission. My dose has now been cut down to 25mg, plus I am also taking 400mg Plaquenil, 5mg Prednisolone. Because I have cut down my dose of Imuran I am likely to flare and if so would this be only for a few days until the body adjusts?

Changes in Lupus activity after a change in dose of Imuran (azathioprine) may not be noticed for a few weeks as it is a slow acting tablet. When the dose is reduced, the benefit of the previously higher dose will last a few weeks. However, when the disease might reactivate after a lowering of therapy could be delayed some time (weeks, months or years) as it may depend on when something next comes along to trigger the disease eg exposure to UV light, infection etc.

The Mirena coil suits most Lupus patients, especially those who have already had one pregnancy. It is very small, releases small amounts of Progesterone which is safe in Lupus and is rarely associated with infection – but it is always best to check with your own specialist.

Loss of hair is usually due to Lupus rather than drug side-effects. Prednisolone tablets or steroid scalp lotions help the quickest. Hydroxychloroquine, Azathioprine and Methotrexate work more slowly to help prevent loss of hair. Oral Cyclophosphamide is the drug most likely to cause loss of hair, but this is rare with intravenous infusions.

There is an increased risk of miscarriage or stillbirth, but pregnancy can be successful and does not always cause a deterioration in lupus in the mother. the best outcomes are achieved if the mother's disease is well controlled. Careful management with close liaison between the GP, hospital physician and obstetrician are required, and it is essential that the mother does not suddenly stop all drug treatment on discovering that she is pregnant. It is preferable for women to plan pregnancy while on appropriate treatment. The oral contraceptive pill should not be prescribed without discussion with the hospital specialist, as oestrogens may exacerbate lupus.

YES - urinalysis for protein and blood is mandatory in any case of "possible SLE". If positive, and

infection excluded, urgent referral to a specialist is advised.

Are there any abnormalities on routine blood tests which are often associated with 

Lupus and support the diagnosis?

YES - low lymphocyte counts are very common but low neutrophil counts, total white count or

platelets may be found, and the ESR is usually (but not always) elevated.

Fatigue, skin rashes (often photosensitive), mouth ulcers, arthralgia (with
little joint swelling), myalgia and pleuretic chest pains.

Information Soon