Understanding Lupus, ANA, and Your Treatment Options: Hydroxychloroquine and Mycophenolate Mofetil
Dr. Benjamin Friedman is a rheumatologist practicing in New York, NY. Dr. Friedman specializes in the treatment of musculoskeletal diseases and systematic autoimmune conditions that can affect the bones, muscles or bones. Eventually, if not treated, these illnesses can also impact the skin, eyes, nervous system and internal... more
Understanding Lupus, ANA, and Your Treatment Options: Hydroxychloroquine and Mycophenolate Mofetil
Systemic Lupus Erythematosus (SLE) or lupus is a complex autoimmune disease where your immune system mistakenly attacks your own body's tissues. A key player in diagnosing lupus is the detection of antinuclear antibodies (ANA). ANAs are proteins made by the immune system that, unfortunately, target the nucleus of your cells, where your DNA is housed. A positive ANA test is a common characteristic in lupus, often guiding diagnosis and initial treatment plans.
Why is ANA Important in Lupus?
During your initial diagnosis, doctors look for ANA levels with a test that measures how many times blood samples can be diluted before ANA can no longer be detected. A dilution of 1:160 or higher is often suggestive of lupus. Although the presence of ANA is a significant indicator of lupus, once you test positive, the levels of ANA don't usually change drastically over time and are therefore not regularly retested. Instead, your doctor will monitor the disease's activity and check for any kidney issues or other organ involvement using different tests and evaluations like kidney function tests, complete blood counts, and specific immune system assessments.
Treatment Options in Lupus
Hydroxychloroquine (HCQ):
Hydroxychloroquine, commonly known as Plaquenil, is a medication frequently used to manage lupus. It helps by moderating the immune system gently, reducing flare-ups without heavily suppressing your immune defenses. Essentially, HCQ makes it harder for your immune cells to communicate, slowing down their activity, which can help decrease the severity of the symptoms.
What Should Patients on HCQ Monitor?
While HCQ is beneficial, it's not without risks. The most significant concern is its potential effect on your eyes, particularly the retina. It's recommended that anyone on HCQ undergo a thorough eye exam before starting the medication and follow-up with regular screenings—initially, these may be annual but can become more frequent depending on your doctor’s advice and any emerging symptoms.
Mycophenolate Mofetil (MMF):
Mycophenolate mofetil, or CellCept, is another medication used to treat lupus, particularly when your symptoms are more severe or if you're experiencing complications affecting your kidneys. MMF targets the way certain cells in your immune system (both B cells and T cells) multiply and function. B cells are particularly problematic in lupus as they produce antibodies that attack your own tissues. MMF is quite effective in reducing these cells' activity, thereby decreasing the overall immune response that contributes to lupus symptoms.
Why Does MMF Focus on B Cells?
MMF is especially good at controlling B cells because it inhibits a specific pathway they use to proliferate and survive. Since these cells are major contributors to the inflammation and damage seen in lupus by producing harmful antibodies, targeting them reduces the severity of the disease. T cells are also affected by MMF, but the impact is less pronounced, which is beneficial as it allows these cells to continue protecting against viruses and other pathogens.
What Should Patients on MMF Monitor?
Patients using MMF should undergo regular health checks, including blood tests to monitor their overall cell counts and organ function, especially the kidneys. Gastrointestinal issues are the most common side effects, so it’s important to report any stomach discomfort, diarrhea, or unusual symptoms to your healthcare provider.
Final Thoughts
Living with lupus means dealing with a disease that can affect almost any part of the body and requires careful, continuous management. By working closely with your healthcare providers and understanding the roles and risks of medications like HCQ and MMF, you can lead a healthier, more comfortable life. Remember, your healthcare team is there to support you at every step, providing guidance and information to help manage your condition effectively.
