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http://www.medscape.com/viewarticle/805186?nlid=31645_681&src=wnl_edit_medn_imed&uac=72556MJ&spon=18
http://jcem.endojournals.org/content/early/2013/05/24/jc.2013-1516.abstractView Thread

Zostavax may be helpful, but is somewhat controversial. Some of the issues that are relevant to the zostavax and lupus are: 1. This is a live vaccine. 2. A low grade viral infection has been reported following the vaccine. 3. It is not clear, though there is significant concern, if using a live vaccine in patients who have active autoimmune disease might trigger a worsening of the autoimmune syndrome. This matter is currently under investigation and we may have some answers in the coming year. 4. Patients who are on immunosuppressive therapy may have a severe viral infection from the virus in the vaccine.
An option that I offer my patients with active lupus, who have recurrent attacks of shingles is to go on anti zoster suppressive therapy with acyclovir or valacyclovir.View Thread


Dear Lupylisa,
I'm so sorry that things are not going great for you. I think you had reached out earlier with a similar question. If I remember correctly, your lupus nephritis was not responsive to cytoxan. In cases where the standard treatments are not working, we consider unapproved/ non-standard approaches.
There are numerous case reports that Rituximab might be of benefit in cases of lupus nephritis. As you may know, when Rituximab was studied in a controlled study, it failed to meet the primary end points. The trial design, where all patients were given high doses of steroids up front and the numbers of patients were not high enough to detect significant differences has been criticized extensively. This might explain why the drug did not meet the endpoints. Having said that many doctors in the lupus community, myself included, have had success in some patients with lupus using that drug. This might be an option for you to consider.
Additionally, we have been studying some medications for lupus nephritis including abatacept and we will know our preliminary data in the next month or so. A medication called epratizumab is being studied and Belimumab is also being studied in clinical trials for nephritis. Most clinical trials for nephritis require a recent renal biopsy, and I think that might be an issue for you given your past experience of bleeding after the procedure. However, depending on how bad your proteinurea is, there might be some trials that you could qualify for without a renal biopsy.
Hope that helps. Wishing you the best!View Thread


In terms of the issue raised below by eyeinthesky below, there are several ocular side effects of hydroxychloriquine. The blurry vision that occurs in the first few weeks of starting the medication is considered a benign side effect and usually goes away after a few weeks of taking the medication.
The more serious toxicity of plaquenil, which is retinal toxicity, occurs after many years of use and occurs due to the deposition of the medicine in the retina. Per the new American Ophthalmological Society guidelines, this risk is much higher after taking 1000 grams. This does not mean that all patients who have had over 1000 grams must stop the medicine. Plaquenil remains a very effective, useful and safe medicine for most lupus patients. However, it means that very vigilant monitoring needs to occur and every patient should be screened by a qualified opthalmologist to determine if they have any signs of retinal involvement.
Hope that clarifies this issue.View Thread


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