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Kemoterapi dan Lupus Wednesday, December 21, 2005 Assalamualaikum wr wb Tina, Bogor Waalaikumussalam wr wb Oleh karena itu, obat yang diberikan bisa sama, bisa pula diberikan tambahan obat yang berbeda, sesuai dengan gejala yang muncul. Prednison, yang merupakan obat golongan kortikosteroid, adalah obat yang cukup sering diperlukan oleh Odapus. Dosisnya tentu disesuaikan oleh dokter, tergantung dari gejala yang timbul dan respons dari pasien. Namun terkadang dibutuhkan obat-obat lain seperti obat antimalaria dan obat sitotoksik yang juga digunakan sebagai obat kemoterapi pada pasien kanker. Pemberian suatu obat, didasarkan pada mekanisme kerjanya. Jadi, mungkin saja obat yang sama digunakan untuk dua penyakit yang kelihatannya berbeda, misalnya parasetamol yang dapat digunakan untuk menurunkan demam juga menghilangkan nyeri. Yang digunakan sebagai dasar pemberian obat pada lupus adalah jika obat tersebut efektif untuk menekan sistem imun (kekebalan tubuh). Saya kira Mbak Tina sudah mengetahui bahwa penyakit lupus disebabkan karena adanya antibodi (zat kekebalan tubuh) yang bekerja berlebihan sehingga menyerang organ-organ tubuh yang sehat. Untuk itu, diperlukan obat yang dapat menekan sistem kekebalan tubuh tersebut agar tidak berlebihan bekerja. Obat sitotoksik pada Odapus berperan sebagai imunosupresan, artinya berperan untuk menekan sistem imun pada tubuh. Obat imunosupresan biasanya diberikan untuk mengatasi gejala yang berat, di mana dibutuhkan pemberian obat golongan kortikosteroid (prednison) dosis tinggi. Padahal, dosis prednison yang terlalu tinggi dapat menimbulkan efek samping yang berat, yang mungkin bisa lebih berbahaya dibandingkan penyakitnya. Oleh karena itu, diberikan obat imunosupresan dalam jangka waktu tertentu (biasanya paling lama enam bulan) untuk mengganti atau diberikan bersama-sama dengan prednison sehingga dosisnya tidak usah terlalu tinggi. Jadi, obat imunosupresan dalam pengobatan lupus berguna untuk mengontrol aktivitas penyakit pada organ-organ vital seperti ginjal, otak, jantung, dan paru, serta dapat mengurangi atau meniadakan kebutuhan akan obat kortikosteroid. Dokter tentu akan memberikan obat imunosupresan, juga obat-obat lain, dengan hati-hati, setelah mempertimbangkan manfaat dan risikonya. Jika penyakit telah terkontrol, dapat saja pemberian obat-obatan dihentikan dan yang perlu dilakukan adalah menjaga asupan nutrisi dan pola hidup.
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~~~ INCREASED PREVALENCE OF HEART ATTACKS IN LUPUS PATIENTS Thursday, December 01, 2005 INCREASED PREVALENCE OF HEART ATTACKS IN LUPUS PATIENTS
~~~ Immune Thrombocytopenic Purpura (ITP)
Immune Thrombocytopenic Purpura (ITP) is a disorder of the blood. Immune refers to the immune system's involvement in this disorder. Antibodies, part of the body's immunologic defense against infection, attach to blood platelet, cells that help stop bleeding, and cause their destruction. Thrombocytopenia refers to decrease in blood platelet. Purpura refers to the purplish- looking areas of the skin and mucous membranes (such as the lining of the mouth) where bleeding has occurred as a result of decreased platelet. Some cases of ITP are caused by drugs, and others are associated with infection, pregnancy, or immune disorders such as systemic lupus erythematosus. About half of all cases are classified as "idiopathic," meaning the cause is unknown. The main symptom is bleeding, which can include bruising ("ecchymosis") and tiny red dots on the skin or mucous membranes ("petechiae"). In some instances bleeding from the nose, gums, digestive or urinary tracts may also occur. Rarely, bleeding within the brain occurs. The physician will take a medical history and perform a thorough physical examination. A careful review of medications the patient is taking is important because some drugs can be associated with thrombocytopenia. A complete blood count will be done. A low platelet count will establish thrombocytopenia as the cause of purpura. Often the next procedure is a bone marrow examination to verify that there are adequate platelet-forming cells (megakaryocyte) in the marrow and to rule out other diseases such as metastatic cancer (cancer that has spread to the bone marrow) and leukemia cancer of the blood cells themselves). Another blood sample may be drawn to check for other conditions sometimes associated with thrombocytopenia such as lupus and infection. Acute and Chronic Form of Thrombocytopenic Purpura Acute (temporary) thrombocytopenic purpura is most commonly seen in young children. Boys and girls are equally affected. Symptoms often, but do not necessarily, follow a viral infection. About 85 percent of children recover within 1 year and the problem doesn't return. Thrombocytopenic purpura is considered chronic when it has lasted more than 6 months. The onset of illness may be at any age. Adults more often have the chronic disorder and females are affected two to three times more than males. The onset of illness may be at any age. If the doctor thinks a drug is the cause of the thrombocytopenia, standard treatment involves discontinuing the drug's use. Infection, if present, is treated vigorously since control of the infection may result in a return of the platelet count to normal. The treatment of idiopathic thrombocytopenic purpura is determined by the severity of the symptoms. In some cases, no therapy is needed. In most cases, drugs that alter the immune system's attack on the platelet are prescribed. These include corticosteroids (i.e., prednisone) and/or intravenous infusions of immune globulin. Another treatment that usually results in an increased number of platelet is removal of the spleen, the organ that destroys antibody-coated platelet. Other drugs such as vincristine, azathioprine (Imuran), Danazol, cyclophosphamide, and cyclosporine are prescribed for patients only in the severe case where other treatments have not shown benefit since these drugs have potentially harmful side effects. Except in certain situations, (e.g., internal bleeding and preparation for surgery), platelet transfusions usually are not beneficial and, therefore, are seldom performed. Because all therapies can have risks, it is important that overtreatment (treatment based solely on platelet counts and not on symptoms) be avoided. In some instances lifestyle adjustments may be helpful for prevention of bleeding due to injury. These would include use of protective gear such as helmets and avoidance of contact sports in symptomatic patients or when platelet counts are less than 50,000. Otherwise, patients usually can carry on normal activities, but final decisions about activity should be made in consultation with the patient's hematologist. Where Can I Obtain Further Information on ITP? Blood specialists (hematologists) are experts in the diagnosis and treatment of these disorders. These doctors practice in most mid- and large-size cities. A majority of medical centers have hematology divisions in their medicine or pediatrics departments, and patients who need evaluation, treatment, or information can often be referred there. source
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