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Live Longer and Better With Lupus
Donald Thomas, MD, FACP, FACR
Italy 959 AD
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Hebernus Hildricus
Éracle
Liège Belgium
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The bishop of Liège, Hildricus by name … an honest and moral man… by a secret judgement of God, pitiably Or rather extraordinarily, troubled with a disease that is popularly called lupus
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It was a misery to behold him, so severely was the strength of the illness raging, consuming, devouring the man’s flesh, though feeding on the outside, Was more intimately Consuming his internal matter.
www.breathoffreshairphotography.com Jenessasdinners.blogspot.com
www.breathoffreshairphotography.com Jenessasdinners.blogspot.com
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Life Magazine, June 6, 1949
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Francis Page: Quinacrine Trial, 1950
Francis Page: Quinacrine Trial, 1950
17/18 discoid lupus cleared
1 systemic lupus improved
2 rheumatoid arthritis improved
Francis Page: Quinacrine Trial, 1950
22
Drugs Approved and Drugs Used to Treat SLE
BENLYSTA
Benefits of antimalarials
•↑ life span
Benefits of antimalarials
• ↑ life span
•↓ steroid doses
Benefits of antimalarials
• ↑ life span
• ↓ steroid doses
•↓ internal organ disease
Benefits of antimalarials
• ↑ life span
• ↓ steroid doses
• ↓ internal organ disease
•↓ diabetes
•↓ cholesterol
•↓ blood clots
Benefits of antimalarials
• ↑ life span
• ↓ steroid doses
• ↓ internal organ disease
• ↓ diabetes
• ↓ cholesterol
• ↓ blood clots
•↓ infections
Benefits of antimalarials
• ↑ life span
• ↓ steroid doses
• ↓ internal organ disease
• ↓ diabetes
• ↓ cholesterol
• ↓ blood clots
• ↓ infections
•↑ energy
Benefits of antimalarials
• ↑ life span
• ↓ steroid doses
• ↓ internal organ disease
• ↓ diabetes
• ↓ cholesterol
• ↓ blood clots
• ↓ infections
•↑ birth rates
Benefits of antimalarials
• ↑ life span
• ↓ steroid doses
• ↓ internal organ disease
• ↓ diabetes
• ↓ cholesterol
• ↓ blood clots
• ↓ infections
•↑ REMISSION
Problem
•50%
Problem
•50% of
patients take their
Plaquenil
Koneru S et al. Adherence to
medications in systemic lupus
erythematosus. JCR.2008;14(4):195
www.livingwithhemophilia.ca
www.livingwithhemophilia.ca
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Virus
↓ Vitamin
D
↓ Vitamin
D
↓ Vitamin
D
46
Michelle Petri, MD
“What happens in lupus when
we improve vitamin D levels?”
Petri M, et al. Vitamin D
In systemic lupus;
A&R;7/13;65(7):1865
48
Incandescent Compact fluorescent LED
Highest UV No UV
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Sulfa antibiotics
Stress
Stress
↓ Vitamin
D
The
Lupus
Secrets
Causes of Death in Lupus
Causes of Death in Lupus
• 1st – Heart attacks, strokes, blood clots
Causes of Death in Lupus
• 1st – Heart attacks, strokes, blood clots
•2nd – Infections
Causes of Death in Lupus
• 1st – Heart attacks, strokes, blood clots
• 2nd – Infections
•3rd – Severe lupus organ disease
Causes of Death in Lupus
• 1st – Heart attacks, strokes, blood clots
• 2nd – Infections
• 3rd – Severe lupus organ disease
•4th - Cancer
Prevent Infections
•Vaccines
Prevent Infections • Vaccines
–Flu shots
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Prevent Infections • Vaccines
– Flu shots
–Pneumonia shots
Pneumovax
Prevnar
www.wikipedia.org
Prevent Infections
• Vaccines
– Flu shots
– Pneumonia shots
–Shingles shot
(Zostavax) www.escholarship.org
65 Curtis J et al, EULAR abstract 2014
Incidence of shingles per 1000 – person years
66 Curtis J et al, EULAR abstract 2014
Incidence of shingles per 1000 – person years
67 Curtis J et al, EULAR abstract 2014
Incidence of shingles per 1000 – person years
Prevent Infections •Vaccines
– Flu shots
– Pneumonia shots
– Shingles shot (Zostavax)
–Gardasil if < 27 yo
Prevent Infections
• Vaccines
•Fever → See Doc ASAP
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Prevent Infections • Vaccines
• Fever → See Doc ASAP
•Don’t smoke
Prevent Infections • Vaccines
• Fever → See Doc ASAP
• Don’t smoke
•Safest Lupus Treatments
– Vitamin D
– Ultraviolet light protection
– Plaquenil (hydroxychloroquine)
72
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The Lupus “Secrets”
