Supportive Treatments for Lupus Comorbidities

Comorbidity is the word for a health condition that occurs at the same time as your main health condition. People with lupus often have comorbidities due to chronic inflammation, organ issues, or other factors. Some of the most common comorbidities in people with lupus include:

• Cardiovascular disease
• Brain and nerve disorders
• Blood complications
• Osteoporosis

Treatments for cardiovascular disease

With cardiovascular disease, "cardio" means heart, and “vascular” refers to the veins, arteries, and capillaries. Many people refer to it as "heart disease," even though the veins and arteries are impacted too. The type of medicine your doctor will prescribe for lupus-related cardiovascular disease will depend on what type of heart disease you have:^1-3

• Daily aspirin may be prescribed to lower the risk of heart attack and stroke.
• Statins help lower blood cholesterol levels. Statins may also lower levels of C-reactive protein.
• Blood pressure drugs lower high blood pressure (hypertension).
• Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed for mild cases of inflammation of the sac around the heart (pericarditis). Steroids are given in more serious cases of pericarditis.
• Blood thinners(anticoagulants) may be ordered to help prevent blood clots.

Other options for treating lupus-related heart disease include:²

• Taking your antimalarials as directed to help lower blood cholesterol levels and inflammation in the body.
• Lifestyle changes such as smoking cessation, weight loss, and exercise.

Treatments for nerve and brain disorders

Lupus frequently attacks the nerves and brain tissue, which can cause pain, seizures, and mood disorders. If this happens to you, your doctor may treat the comorbidity with the following drugs:^4-9

• Anticonvulsants may be prescribed to control seizures. NSAIDs or non-steroidal anti-inflammatory drugs (ibuprofen or naproxen), antimalarials and steroids may also be used as part of a treatment plan.
• Antidepressants or anti-anxiety drugs may be given to reduce symptoms of depression and anxiety. Exercise, good sleep habits, counseling, and better pain control may also be needed to control these conditions.
• Antipsychotics or antidepressants may be needed to treat hallucinations, delusions, and severe mood swings.
• Steroids may help treat some forms of psychosis and make other types worse.
• Aspirin or anticoagulants may be prescribed to prevent blood clots that may cause a stroke (blood clot in the brain).

Treatments for lupus-related blood issues

The inflammation of lupus creates many problems with the blood. Sometimes these comorbidities are caused by the way bone marrow works. At other times, lupus antibodies attack blood cells, preventing them from working correctly. Many treatments exist for the blood issues caused by lupus, such as:^10-15

• Anemia (too few red blood cells) may be treated with steroids, iron pills, erythropoietin, darbepoetin, or a splenectomy.
• Immunosuppressants are given for mild cases of low platelet counts (thrombocytopenia). High doses of steroids may be taken for more severe cases. If steroids do not work, IV immunoglobulin, azathioprine, cyclophosphamide, or rituximab, or splenectomy may be used.
• Anticoagulants and aspirin may be prescribed for blood clots and antiphospholipid syndrome.
• Low white blood cell count is treated with immunosuppressants or antibiotics, depending on what caused the low cell count.

Treatments for lupus-related osteoporosis

People with lupus are vulnerable to osteoporosis, or thinning of the bones. The steroids often used to treat lupus inflammation can cause the condition. Plus most people with lupus are women and women are more likely to experience bone loss. Osteoporosis can be treated with drugs, exercise, and diet.

Medicines and lifestyle changes used to treat osteoporosis include:^16-18

• Bisphosphonates encourage the cells that build bones to work better, which improves bone density.
• Weight-bearing exercise, such as walking, dancing, or weight-lifting, helps build bones.
• The nutrientscalcium and vitamin D to build and maintain healthy bones and help bisphosphonates work better.
• The drugs calcitonin; estrogen (hormone therapy); estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERM); parathyroid hormone (PTH) analog; parathyroid hormone-related protein (PTHrp) analog; RANK ligand (RANKL) inhibitor; and tissue-selective estrogen complex (TSEC) may be prescribed for more serious cases of osteoporosis.