The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Tips for Treating Lupus-Related Renal Disease, Pain, Alopecia

Tips for Treating Lupus-Related Renal Disease, Pain, Alopecia

January 19, 2018 • By Susan Bernstein

  • Tweet
  • Email
Print-Friendly Version / Save PDF
Hair loss is commonly seen in lupus patients, but not all alopecia types are the same.

Hair loss is commonly seen in lupus patients, but not all alopecia types are the same.
Dr P. Marazzi/Science Source

SAN DIEGO—Rheumatologists who treat lupus patients gleaned tips on diagnosis and management of renal disease, painful neuropathies and alopecia at a “Curbside Consults” session held Nov. 6 at the ACR/ARHP Annual Meeting in San Diego.

You Might Also Like
  • Tips for Treating Pain, Depression in Patients with Rheumatic Disease Offered at the ACR/ARHP’s 2013 Annual Meeting
  • Renal Transplant Outcomes in Patients with Lupus Nephritis
  • Antiplatelet Therapy May Protect Renal Function in Some Lupus Patients
Explore This Issue
January 2018
Also By This Author
  • The ACR Extends Its Global Outreach with a New Task Force

Membranous Lupus Nephritis

Patients with refractory membranous lupus nephritis (MLN), or Class V lupus nephritis, face “significant morbidity, most of which is related to nephrotic syndrome and hypo-albuminemia,” said Ellen M. Ginzler, MD, MPH, distinguished teaching professor of medicine and chief of rheumatology at SUNY Downstate Medical Center in Brooklyn, N.Y. About 20% of lupus nephritis patients have MLN, and 10% may progress to end-stage renal disease after 10 years.1

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

“So this is not a trivial problem. It’s important to think about possible consequences when you choose initial treatment,” including women who wish to become pregnant later, she said. Current ACR guidelines recommend pulse prednisone with a range of 0.5 to 1 mg/kg a day and immunosuppressant therapy, but “the question is which immunosuppressant drug to use?”2 Both the ACR and EULAR guidelines suggest mycophenolate mofetil (MMF), but intravenous cyclophosphamide is another option.3 She shared a case of a nulliparous, 32-year-old woman with MLN who started on 30 mg of prednisone and 3 g of MMF daily, and Dr. Ginzler suggested that African American and Afro-Caribbean patients may do better on the higher range of the recommended dose.

Although her patient’s blood pressure was normal, Dr. Ginzler also prescribed losartan, an angiotensin receptor blocker (ARB). ARBs and angiotensin-converting enzyme inhibitors “may lower proteinuria, but give you a false sense of security, because what they do is decrease renal blood flow, not really affecting the glomerular pathology” in MLN patients, she said. When her patient later wanted to conceive, she switched from MMF to azathioprine, although it can elevate risk of renal flare in some patients, said Dr. Ginzler.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

“Unfortunately, my patient was one of them, and eight months later, she had a flare, and again had hypo-albuminemia and significant nephrotic syndrome,” she said. Renal biopsy confirmed that she still had pure MLN, so she restarted induction therapy with a slightly higher prednisone dose. She redeveloped leg edema, still had proteinuria, and was later confirmed to have renal vein thrombosis. She started anticoagulation therapy, and then Dr. Ginzler and her colleagues chose to also start cyclosporin, a calcineurin inhibitor, based on current guidelines. Trials of calcineurin inhibitors are few, small, mainly anecdotal and do not focus on patients with pure MLN, she said. One meta-analysis focused on pure MLN patients suggests rituximab is another option, with 40% of patients achieving complete and 27% achieving partial response.4

Pages: 1 2 3 4 | Single Page

Filed Under: Conditions, Meeting Reports, SLE (Lupus) Tagged With: AC&R, ACR/ARHP Annual Meeting, alopecia, American College of Rheumatology, ARHP, Association of Rheumatology Health Professionals, Lupus, Pain, patient care, Renal, rheumatologist, TreatmentIssue: January 2018

You Might Also Like:
  • Tips for Treating Pain, Depression in Patients with Rheumatic Disease Offered at the ACR/ARHP’s 2013 Annual Meeting
  • Renal Transplant Outcomes in Patients with Lupus Nephritis
  • Antiplatelet Therapy May Protect Renal Function in Some Lupus Patients
  • Causes of Alopecia Can Vary Among Patients with Systemic Disease Say Experts at the 2013 ACR/ARHP Annual Meeting

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.