* NSAIDs
Pronounced “ensayds,” these drugs help reduce pain and swelling in the joints while decreasing stiffness. When a low dose is taken, NSAIDs control pain, but higher doses are required to reduce inflammation. The problem with NSAIDs is their side effects. Taking more than one NSAID at a time increases the possibility of heartburn and severe side effects such as ulcers and bleeding. NSAIDs inhibit the blood’s ability to clot properly and may therefore interact with blood-thinning medications such as coumadin. Kidney disease has also been reported as a side effect.

Most NSAIDs require a prescription, including naproxen (Naprosyn®), nabumetone (Relafen®), indomethacin (Indocid®), diclofenac (Voltaren®), piroxicam (Feldene®) and sulindac (Clinoril®). Other NSAIDs are available over-the-counter; these include ASA (Aspirin®, Anacin® and others), and ibuprofen (Motrin IB®, Advil® and others.)

* COX-2 Inhibitors
This sub-class of NSAID has recently been introduced to the North American marketplace. The most frequently prescribed Cox-2 inhibitors are celecoxib (Celebrex®), rofecoxib (Vioxx®), valdecoxib (Bextra®) and meloxicam (Mobicox®). Unlike standard NSAIDs, Cox-2 inhibitors do not inhibit proper blood clotting. Recent evidence, however, strongly suggests that Cox-2 inhibitors have the same degree of negative side effects as standard NSAIDs—including contributing to kidney failure—and may increase the risk of heart attack and other cardiovascular problems.

*Important News Release September 2004
Vioxx®, the cox-2 inhibitor made by Merck, has been pulled from the market because of severe lethal side effects due to heart attack and stroke.

* ACETAMINOPHEN
Acetaminophen (Tylenol®, Panadol®, Exdol®, and others) is often prescribed to relieve mild to moderate joint pain. Acetaminophen is not an anti-inflammatory drug and may therefore usually be safely combined with an anti-inflammatory medication to relieve pain. (Please consult your doctor or other health care practitioner regarding medications that are appropriate for you.)

While acetaminophen can bring relief for joint pain, it does not help the underlying cause of the condition. Overdosing can cause liver damage. (If you are taking acetaminophen on a regular basis to control pain, you should make sure that other over-the-counter medications such as cold and flu remedies do not contain enough acetaminophen to constitute an overdose.)

* CORTICOSTEROIDS
Cortisone is a steroid that is naturally produced by the body. It reduces swelling and inflammation and can help regulate the immune system. Corticosteroids are man-made drugs that closely resemble cortisone but have a much more powerful effect on inflammation. The most common form of corticosteroid is called prednisone. Oral prednisone is usually considered when the symptoms of systemic lupus erythematosus (SLE) are not being controlled by other treatments, and there is concern about an imminent flare-up, or when the disease is severe and perhaps life threatening. Prednisone use needs to be carefully monitored because of its many side effects, and the drug must never be stopped abruptly.

Side effects from long term use of corticosteroids may include cataracts, high blood pressure, sleep problems, muscle loss, bruising, thinning of the bones (osteoporosis and osteopenia), weight gain, immune suppression and increased susceptibility to infections. The goal with these drugs is to find the lowest effective dose that will avoid as many of the side effects as possible.

* ANTI-MALARIALS
Anti-malarial medications help to manage the fatigue, skin rashes and joint pain associated with lupus. Chloroquine (Aralen®) and hydroxychloroquine (Plaquenil®) are examples of antimalarial medications. They may take several months to take effect.

The most common side effect of anti-malarial medications is stomach upset. A more serious, although rare, side effect is loss of vision. This may occur if anti-malarials are taken in high doses over a long period of time. If you are prescribed an anti-malarial, you will probably be required to have an eye examination before starting the medication, and have regular follow-up eye examinations.

* CYTOTOXIC DRUGS
Cytotoxic drugs are often prescribed to control inflammation by suppressing the immune system. For this reason, they are also known as immunosuppressive drugs. You may be prescribed these if your symptoms are difficult to control with prednisone alone or if you are experiencing side effects from prednisone. Cyclophosphamide (Cytoxan®), cyclophosphamide (Procytox®) and azathioprine (Imuran®) are commonly prescribed cytotoxic drugs.

Serious side effects include decreased blood cell counts, increased risk of infection and a risk of developing certain types of cancer. If you have lupus and you are taking cytotoxic drugs, you should have regular blood tests and be monitored closely by your doctor or other health practitioner.