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Managing Infections for Lupus Patients - Highlights from Dr. Curran's Presentation
On August 9, 2012, the LSI hosted an educational teleconference “Managing and Preventing Infections for Lupus Patients” presented by Dr. James Curran.  The event included a presentation by Dr. Curran followed by Q&A from the callers. The article below is based on information obtained from the teleconference.  The entire transcript will be available online in the next few weeks.

The second leading cause of death in SLE is infection – making managing and preventing infections a top priority for lupus patients.  Lupus patients are at greater risk for many reasons;  most are on immunosuppressive therapy at one point or another, pathogen exposure at office visits and lupus itself causes a dysfunction of the normal immune response to name a few.

Treatments may also contribute to the high infection rate.  The new biologic medications (rituximab, orencia and Benlysta) can increase the risk of infection.  Corticosteroids, including prednisone, increase the risk of infection.   The higher the dose of corticosteroids you’re on, the longer you’re on the dose, the greater the risk of infection.

The incidence of infections in lupus patients – especially life-threatening infections – appears to be highest in the first five years of the disease.  One reason for this might be that in the first five years, patients are undergoing treatment that is modifying their immune response.

Infections lupus patients should be mindful of include bacterial, viral and fungal.  Some common threats to lupus are pneumococcal pneumonia or streptococcus pneumonia, Haemophilus influenza and staphylococcus aureus.  Lupus patients have a predilection towards salmonella which in lupus patients frequently causes osteomyelitis or bone infections.  Shingles is more common in lupus patients than the general public.  Yeast infections are also common in lupus patients.

Other non-hospitalized infections include respiratory tract infection, sinusitis, urinary tract infections and skin infections.  Usually with aggressive treatment and early diagnosis, these infections do not require hospitalization.

What can you do to protect yourself again getting an infection?  

First, non-live vaccines are recommended.  That would include the flu shot (NOT the flu vaccine administered through the nasal passages), Pneumococcal vaccine every 5-10 years, a Bordetella pertussis booster, Hepatitis B (for healthcare workers) and meningococcal to name a few.

If you are on a biologic, be aware that the biologic medicine may impair the normal response to a vaccine.  If you have lupus, you should be vaccinated before you use any biologic and before taking major immunosuppressant medications.

Plaquenil, hydroxychloroquine, decreases the risk of infections.  A 2009 study showed that individuals on Plaquenil are 16 times less likely to get a major infection when taking the drug – regardless of whether or not corticosteroids are also taken.  So, patients on corticosteroids and Plaquenil had fewer infections than patients on steroids alone.

Other things you can do to manage infections are to be sure to get treated with antibiotics if you are sick.   Be sure to use bactericidal drugs – drugs that kill the bacteria instead of freeze it.  Lupus patient’s immune system needs to kill the bacteria.

In conclusion, remember vaccinations are very important – avoid live viruses. Plaquenil reduces risk of infection.  Limit your exposure to infection.

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