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Maryland summit jhh 2015 how to live longer and better with lupus
- 1. Live Longer and Better With Lupus Donald Thomas, MD, FACP, FACR
- 5. 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
- 7. 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.
- 12. Life Magazine, June 6, 1949
- 15. Francis Page: Quinacrine Trial, 1950
- 16. Francis Page: Quinacrine Trial, 1950
- 17. 17/18 discoid lupus cleared 1 systemic lupus improved 2 rheumatoid arthritis improved Francis Page: Quinacrine Trial, 1950
- 22. 22 Drugs Approved and Drugs Used to Treat SLE BENLYSTA
- 23. Benefits of antimalarials •↑ life span
- 24. Benefits of antimalarials • ↑ life span •↓ steroid doses
- 25. Benefits of antimalarials • ↑ life span • ↓ steroid doses •↓ internal organ disease
- 26. Benefits of antimalarials • ↑ life span • ↓ steroid doses • ↓ internal organ disease •↓ diabetes •↓ cholesterol •↓ blood clots
- 27. Benefits of antimalarials • ↑ life span • ↓ steroid doses • ↓ internal organ disease • ↓ diabetes • ↓ cholesterol • ↓ blood clots •↓ infections
- 28. Benefits of antimalarials • ↑ life span • ↓ steroid doses • ↓ internal organ disease • ↓ diabetes • ↓ cholesterol • ↓ blood clots • ↓ infections •↑ energy
- 29. Benefits of antimalarials • ↑ life span • ↓ steroid doses • ↓ internal organ disease • ↓ diabetes • ↓ cholesterol • ↓ blood clots • ↓ infections •↑ birth rates
- 30. Benefits of antimalarials • ↑ life span • ↓ steroid doses • ↓ internal organ disease • ↓ diabetes • ↓ cholesterol • ↓ blood clots • ↓ infections •↑ REMISSION
- 31. Problem •50%
- 32. Problem •50%of patients take their Plaquenil Koneru S et al. Adherence to medications in systemic lupus erythematosus. JCR.2008;14(4):195
- 37. Virus
- 38. ↓ Vitamin D
- 44. ↓ Vitamin D
- 45. ↓ Vitamin D
- 46. 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. 48 Incandescent Compact fluorescent LED Highest UV No UV www.outlookcolumbus.com
- 53. Stress
- 56. Causes of Death in Lupus
- 57. Causes of Death in Lupus •1st – Heart attacks, strokes, blood clots
- 58. Causes of Death in Lupus • 1st – Heart attacks, strokes, blood clots •2nd – Infections
- 59. Causes of Death in Lupus • 1st – Heart attacks, strokes, blood clots • 2nd – Infections •3rd – Severe lupus organ disease
- 60. Causes of Death in Lupus • 1st – Heart attacks, strokes, blood clots • 2nd – Infections • 3rd – Severe lupus organ disease •4th - Cancer
- 62. Prevent Infections • Vaccines –Flu shots www.chaniapost.eu
- 63. Prevent Infections • Vaccines –Flu shots –Pneumonia shots Pneumovax Prevnar www.wikipedia.org
- 64. Prevent Infections • Vaccines –Flu shots –Pneumonia shots –Shingles shot (Zostavax) www.escholarship.org
- 65. 65 Curtis J et al, EULAR abstract 2014 Incidence of shingles per 1000 – person years
- 66. 66 Curtis J et al, EULAR abstract 2014 Incidence of shingles per 1000 – person years
- 67. 67 Curtis J et al, EULAR abstract 2014 Incidence of shingles per 1000 – person years
- 68. Prevent Infections •Vaccines –Flu shots –Pneumonia shots –Shingles shot (Zostavax) –Gardasil if < 27 yo
- 69. Prevent Infections • Vaccines •Fever → See Doc ASAP www.ex48.wordpress.com
- 70. Prevent Infections • Vaccines • Fever → See Doc ASAP •Don’t smoke
- 71. Prevent Infections • Vaccines • Fever → See Doc ASAP • Don’t smoke •Safest Lupus Treatments – Vitamin D – Ultraviolet light protection – Plaquenil (hydroxychloroquine)
- 72. 72