By A. G. Moore
It is estimated that between 50-60% of lupus patients will experience nephritis at some point in the course of their illness. The numbers vary by ethnic group and gender. For example: men, Hispanics and people of Afro-Caribbean origin tend to get nephritis in greater numbers and are inclined to have a more severe course of illness than members of some other groups.
Outcomes for people with lupus nephritis have improved dramatically over the years. This is partly due, it is believed, to more accurate diagnosis and also to more effective treatment.
In 2012, The American College of Rheumatology issued new guidelines for treatment of lupus nephritis. This is the first update issued by the ARC since 1999; the new guidelines reflect the results of many clinical trials. The ACR describes five classes of lupus nephritis, with I being the mildest and V being the most severe. Depending on the class into which a patient’s disease falls, treatment recommendations vary. For class III, IV and V an immunosuppressive agent, in conjunction with prednisone, is recommended.
Clinical trials demonstrate that the use of mycophenolate produces a higher rate of improvement, for some patients, than some other therapies have produced. Of course, doctors must assess the way in which each patient responds to therapy. Treatment protocols need to be to be adjusted accordingly.
Because mycophenolate is a powerful immunosuppressive agent, the risk of developing an infection or for an infection to worsen is increased. So it is important for patients to be alert to any change in health status, whether that change be a blister, sore throat or fever. The doctor should be consulted as soon as an issue is detected.
There are many potential drug interactions with mycophenolate. The doctor should be informed about any preparation the patient might be taking, including herbal supplements and vitamins. Anyone who is allergic to aspartame should tell the doctor about this because it seems aspartame is included in the mycophenolate suspension.
Mycophenolate tamps down the immune system by suppressing cell proliferation, especially proliferation of B cells, which are prime actors in lupus nephritis.
Mycophenolate has been shown to cause birth defects, especially in the first trimester. Any woman of child-bearing age must use two methods of birth control while taking this medicine and she must continue with the birth control regimen for weeks after stopping the medicine—a doctor will advise as to how long this should be.
Although mycophenolatte is a powerful drug which has the potential to cause serious side effects, the drug can be a life-saver. Nephritis should never be underestimated. No patient should be casual about this manifestation of lupus. Early and aggressive treatment is often the to key to a successful outcome. With lupus, it’s always recommended that the patient consult closely with the doctor about any changes in health status. With lupus nephritis, especially when on immune suppressive therapy, the principle under which a patient needs to operate is: keep your doctor informed.
Resources the patient should read:
*ACR Guidelines for Screening, Treatment and Management of Lupus Nephritis: https://docs.google.com/viewer?a=v&
*Should Mycophenolate Mofetil Replace Cyclophosphamide as First-Line Therapy for Severe Lupus Nephritis? http://www.nature.com/ki/journal/vaop/ncurrent/full/ki2012203a.htm