Hydroxychloroquine and NSAIDs: Protecting the Organs

Hydroxychloroquine and non-steroidal anti-inflammatory drugs are important medications for people with lupus that can protect against organ damage in SLE.

There are many lupus medications, including the ever-important corticosteroids. However, two in particular stand out as low-cost, well-tolerated treatments that help to limit organ damage:

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are medications that reduce inflammation and relieve pain. Many NSAIDs can be purchased over the counter, such as ibuprofen and naproxen, though some need to be prescribed.

They work by blocking the enzymes Cox-1 and Cox-2 from producing prostaglandins, pro-inflammatory cytokines that reduce swelling and pain. These medications carry a risk of kidney damage for people with weakened kidneys, and are well-known for their gastrointestinal side. Because of this, NSAIDS can potentially cause complications for people with lupus nephritis.

Some, such as aspirin, have a blood-thinning effects which can potentially cause bleeding in the gastrointestinal system and brain. However, this same blood-thinning effect is also used as a way to prevent blood clots and cardiovascular issues.

NSAIDs are considered to be a staple medication since they are safe overall, and about 80% of people with lupus find benefits from them. Overall, they are effective, but also milder than many lupus medications. You can read more about NSAID medications here.

2. Hydroxychloroquine is the other notable medication. It is a very effective drug for lupus that acts on the lysosomes – the immune system cells that absorb and destroy bodies that the immune system marks for destruction.

Usually considered to be an antimalarial drug, hydroxychloroquine (also known as HCQ) inhibits the ability of lysosomes to function. HCQ helps modulate the immune system, reducing the symptoms of lupus. HCQ can cause damage in the eyes, but otherwise has few side effects for people with lupus. You can read more about hydroxychloroquine here.

Both drugs are considered to be highly valuable in preventing organ damage in people with lupus.

What Organ Damage Happens in SLE?

One of the reasons why lupus is difficult to diagnose and treat is because it has the potential to affect organs throughout the body. The symptoms of lupus can involve the brain, nervous system, muscles, kidneys, gut, and circulatory system in any combination.

The damage to organs usually occurs bit by bit over time, and can occur at different rates for different people. Research shows varied disease progression depending on race and socioeconomic status. Medications have been shown to limit the build-up of damage.

In a study on 1168 patients over 12 months, researchers found that the SELENA-SLEDAI scores, a measure of symptom severity, were a good predictor of organ damage in lupus. This organ damage involves both cardiovascular and kidney damage risks.

Controlling disease activity is often achieved with the support of medications.

Organ Damage and Medications

Because they reduce flares and inflammation, HCQ and NSAIDs can help prevent organ damage in lupus. Hydroxychloroquine, especially, was associated with lower rates of organ damage in general which held true in a different group over 3 years of follow up.

Corticosteroids can be harsh, with sometimes intense side effects, but they will also help prevent damage. In a study on 525 patients, prednisone, a notoriously harsh drug, did not cause irreversible organ damage, even over time – allowing it to do more good than harm.

Though new medications that are more effective and have less side effects would be ideal, any lupus medications – including NSAIDs – will reduce symptoms and prevent organ damage. You can read more about lupus medications here.