Arodis Arias
Michelle Enriquez
Kimberly Goris

Systemic Lupus autoimmune disease.
Causes immune system to make antibodies that
attack the body’s healthy cells and tissues.
Inflames:

Symptoms include:


◦
◦
◦
◦
◦
◦
◦
◦
◦
Joints and muscle pain
Tendons
Skin
Other connective tissues and organs like the heart
Fatigue
Malaise
Hair loss
Oral sores
Butterfly rash

Systemic Lupus Erythematous is unknown.
Studies suggest it may be a combination of:
◦ Genetic factors
◦ Environmental factors, which may include: sunlight,
(UV rays)
◦ Stress
◦ Viral
◦ Drug induced (methyldopa, procainamide,
isoniazid, chlorpromazine, TNF-blocking drugs).

Systemic Lupus - most common

Cutaneous Lupus – “Discoid Lupus”

Drug Induced:
◦
◦
◦
◦
Apresoline
Quinidine
Isoniazid
Dilantin
occur in 5% of people with Lupus



Sex: female to male 10:1
Age: 20-45
Race: African American, Native America, Asian
and Hispanic.

No cure.
Goal of treatment is to control symptoms.

Photo protection: avoid direct sun exposure.

◦ Sunscreens containing dioxide or zinc oxide.
Triamcinolone acetonide 0.1%
Clobetasol propionate 0.05%


Brand Name: Kenalog®, Oralone®, Pediaderm®
MOA : decreases inflammation by suppression of migration of polymorphonuclear
leukocytes and reversal of increase capillary permeability, suppress the immune
system by reducing activity and volume of the lymphatic system.

Adverse effects: Frequency not defined.

Drug Interaction: Avoid concomitant use with Aldesleukin.

Contraindication: Hypersensitivity to triamcinolone or any component of the
formulation; fungal, viral or bacterial infections of the mouth or throat.

Effects on Dental Treatment: ulcerative esophagitis, perioral dermatitis, atrophy
of the oral mucosa, burning and irritation.
Prednisone
Oral Corticosteroids

Brand name: PredniSONE Intensol™

MOA : decrease inflammation. Inmunosuppresion, adrenal function suppresion at
high doses.

Adverse effects: Temporary effects and likely dose related adverse effects like
osteoporosis and adrenal suppression.



Drug Interaction:
◦ Avoid ethanol
◦ Prednisone interferes with calcium absorption. Limit caffeine
◦ St. John’s wart may decrease prednisone levels.
Contraindications: Hypersensitivity to any component of the formulation; systemic
fungal infections; administration of live attenuated vaccines with
immunosuppressive doses of prednisone.
Effects on Dental treatment: No significant effects or complications reported.
Topical Calciuneurin Inhibitors
Tacrolimus (Protopic® 0.1%)
Pimercrolimus



MOA: suppress cellular immunity. (Inhibits T-lymphocyte activation)
Adverse effects: CNS: headache; Dermatologic: skin burning; Respiratory:
increased cough; Cardiovascular: peripheral edema; Gastrointesntinal:
diarrhea; Ocular: conjuctivitis.
Drug Interaction: avoid use of Immunosuppresants and alcohol. Localized
flushing (redness, warm sensation) may occur at applicationsite of topical
following ethanol consumption.

Contraindications: hypersensitivity

Effects on Dental Treatment: No significant effects or complications reported.
Antimalarials
Hydroxychloroquine (Plaquenil®)
Aminoquinolone

MOA: Interferes with digestive vacuole function within sensitive

Adverse effects: Frequency not defined. Cardiovascular:

Effects on Dental Treatment: no significant effects or
malarial parasite.
cardiomyopathy; CNS: ataxia, dizziness, emotional changes;
Dermatologic: alopecia; Gastrointestinal: abdominal cramping,
anorexia, diarrhea, nausea.
complications reported.
Immunosuppressants
AzaTHIOprine (Azasan®; Imuran®)
Methotrexate (Rheumatrex®; Trexall®)
Cyclophosphamide (Cytoxa)





MOA: antagonizes purine metabolism and may inhibit synthesis of DNA, RNA
and proteins; may also interfere with cellular metabolism and inhibit mitosis.
Adverse effects: frequency not always defined; dependant upon dose,
duration, indication, and concomitant therapy.
Drug interactions: avoid conccomitant use with BCG; Febuxostat;
Mercaptopurine.
Contraindication: hypersensitivity to azathioprine or any component of the
formulation.
Effects on Dental Treatment: No significant effects or complications reported.
B-cell Suppresor
RiTUXimab (Rituxan®)
Belimumab (Benylsta®)

MOA: Its an IgG1-lamba monoclonal antibody that prevents survival

Adverse effects: Gastrointestinal: nausea; CNS: fever, insomnia,

Effects on Dental Treatment: No significant effects or
of B lymphocytes. Reduces the activity of B-cell mediatoted
immunity and the autoimmune response.
migrane, depression; Respiratory: bronchitis.
complications reported.





MOA: Management of pain and swelling.
Adverse effects: Cardiovascular: edema; CNS: dizziness; Dermatologic: rash;
Endocrine: fluid retention.
Drug interaction: May increase levels of Anticoagulants; Antiplatelet Agent;
Bisphosphonate derivatives; Collagenase.
Contraindication: associated with an increased risk of adverse cardiovascular
thrombotic events, including fatal MI and stroke.
Effects on Dental Treatment: Ibuprofen can interfere with the antiplatelet
effect of low-dose aspirin (81mg/day), diminishing the effectiveness of
aspirin as used for cardioprotection and stroke prevention.

A connective tissue disease that involves
changes in the:
◦
◦
◦
◦

Skin
Blood vessels
Muscles
Internal organs
An autoimmune disorder when the
autoimmune system attacks and destroys
healthy body tissues




Calcium channel blockers used for Reynaud’s phenomenon.
Corticosteroids – Antiinflammatory
NSAIDs
ACE Inhibitors
Methotrexate Immune suppressing medication
Antineoplastic agaent
MOA: Ultrasoft acting IV barbiturate anesthetic.
Adverse effects: Frequency not defined.
Drug Interaction: None known.
Contraindication: Hypersensitivity to barbiturates (porphyria).
Effects on Dental Treatment: No significant effects or complications reported.
Cyclophosphamide
Antineoplastic agent
MOA: Prevents cell division, and potent immunosuppressive.
Adverse effects: Dermatologic: alopecia; may cause sterility; nausea,
vomiting, anemia, headache, nasal congestion.
Drug Interaction: Increased effect on Vitamin K antagonist.
Contraindication: severely depressed bone marrow function.
Effects on Dental Treatment: mucositis and stomatitis.





Obtain thorough medical history which include all the
medications and side effects.
Maintain patient on strict oral hygiene regimen and recalls.
Recommend powered toothbrush to patient due to lack of
dexterity on their hands.
Advise patient to use WaterPick to clean interproximally since
the patient may not be able to maneuver the dental floss.
Recommend patient to eat a healthy diet.

1. What does Lupus affect?

2. What type of medications are used?


3. What is the most significant symptom of
Scleroderma?
4. What does Raynaud’s phenomenon affect?




You have full text access to this OnlineOpen articleArthritis &
RheumatismVolume 62, Issue 12, Article first published online: 30
NOV 2010
http://www.nlm.nih.gov/medlineplus/ency/article/000435.htm
http://www.medicinenet.com/systemic_lupus/page5.htm#what_is_t
he_treatment_for_systemic_lupus_erythematosus
http://emedicine.medscape.com/article/1064663-treatment