Lupus Treatment

Question 1

Treatment for Lupus & MND

Answer 1

Hydroxychloroquine for all (unless contra-indication)
* Glucocorticoids (e.g. Prednisolone) for acute flare
* Steroid-sparing agents
* Mycophenolate (renal)
* Azathioprine (managing disease in pregnancy)
* Methotrexate (joint and skin)
* Top line for severe disease
* Rituximab (B cell depleting) & Cyclophosphamide

Question 2

Neuropsychiatric Lupus CNS symptoms

Answer 2

-meningitis
- stroke (headache, movement disorder, myelopathy)
- Seizure
- acute confusional state
- cognitive dysfunction
- mood disorder
- psychosis

Question 3

Neuropsychiatric Lupus PNS symptoms

Answer 3

-Mononeuropathy (myasthenia gravis, plexopathy)
- Polyneuropathy

Question 4

Key factors of Lupus treatment

Answer 4

1. Immunosupression:
   - Corticosteroids
   - Cyclophosphamide +/- Rituximab
2. Antipsychotics
3. Time

Question 5

Multidisciplinary approach to motor neuron disease (MND)

Answer 5

-MND Clinical Nurse Specialist
-Joint Palliative Care
-Physiotherapy
-Occupational Therapy
-Speech and language Therapy
-Dietetics
-Neurologist
-Specialist Wheelchair Therapist
-Joint Orthotics Clinic
-Research Nurse
-Rapid access to Specialist Respiratory -Centre (Lane Fox Unit)
-Voice Banking Specialist

Question 6

Medication for management of MND

Answer 6

• Emotional lability: Neudexta?, Antidepressants

-Cramps: Quinine sulphate

-Spasticity: Baclofen, tizanidine, gabapentin, dantrolene

• Sialorrhoea: Hyoscine patches, atropine drops, glycopyronium, amitryptiline, botox, radiotherapy

Question 7

Disease modifying drug for MND

Answer 7

Riluzole – the only disease modifying drug (DMD) in UK for MND

Question 8

what is Tofersen (Qalsody)?

Answer 8

targeted therapy designed to reduce the production of the faulty SOD1 protein associated with ALS.