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. May not be reproduced in any form without permission from the publisher, except fair uses permitted under 36 Ana Maria Abreu Velez and Michael S. Howard

Antimalarials
Antimalarials are another class of drug frequently used in lupus therapy. These
medications, such as hydroxycloroquine, were originally used to treat malaria and are now
utilized to treat lupus [73-75, 102-104, 108-112, 120, 125-128].
Antimalarials may be used alone, or in combination with other drugs; they are generally
used to address fatigue, joint pain, skin rashes, and inflammation of the lungs. Clinical studies
have also found that continuous treatment with antimalarials may prevent flares from
recurring. Side effects of antimalarials may include stomach irritation, and rarely damage to
the retina of the eye [73-75, 102-104, 108-112, 120, 125,126, 127,128].

Corticosteroids
The mainstay of lupus treatment involves the use of corticosteroid hormones, including
prednisone, hydrocortisone, methylprednisolone and dexamethasone [129-133].
Corticosteroids are related to cortisol, which is a natural anti-inflammatory hormone. They
work by rapidly suppressing inflammation. Corticosteroids can be given orally, via topical
creams, by injection or by intravenous (IV) infusion. Corticosteroid side effects generally
cease when drug administration is stopped. It is clinically dangerous to suddenly cease
corticosteroid therapy.
Sometimes, a large amount of therapeutic corticosteroid is administered by IV infusion
over a brief period of time (ie, hours or days), constituting bolus or pulse therapy. Long-
term side effects of corticosteroids include stretch marks on the skin, weakened or damaged
bones (osteoporosis and osteonecrosis), high blood pressure, damage to the arteries, diabetes
mellitus, infections, and cataracts [129-133]
Lupus patients undergoing corticosteroid therapy should discuss adding supplemental
calcium, vitamin D or other agents (to reduce osteoporosis risk) with their physician.

Immunosuppressives
For patients whose renal or central nervous systems are affected by lupus,
immunosuppressive therapy may be considered. Immunosuppressives, including
cyclophosphamide and mycophenolate mofetil, restrain the overactive immune system in
lupus by blocking the production of immune cells. These drugs may be given orally, or via IV
U.S. or applicable copyright law.

infusion [73-75, 102-104, 108-112, 120, 125-133].

Side effects may include nausea, vomiting, hair loss, urinary bladder problems, decreased
fertility, and increased risks of cancer and infection. The risk of side effects increases with the
length of treatment. As with other treatments for lupus, there is also a risk of disease relapse
after the immunosuppressives have been stopped.

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