Complementary Medicine and the Management of Systemic Lupus Erythematosus



by Soram Singh Khalsa MD

Los Angeles, California, USA.

(First printed in Lupus UK News & Views, Winter 1997 Number 53.)

(With thanks to the Lupus Foundation of America. This article has been shortened.)


In recent years there has been a surge in the interest and use of "alternative" or "complementary" therapies in the treatment of illness, including lupus erythematosus. What is complementary medicine and how can it be used to help people with lupus?



Defining Alternatives

Complementary medicine, functional medicine, alternative medicine and holistic medicine are all synonyms for the many natural treatment modalities which can be used in addition to traditional pharmaceuticals and surgery. the use of the term "Complementary medicine" emphasises the nature of these types of therapies in complementing traditional western medicine. I always explain to my patients that the modalities we will be using are in addition to, not instead of, the current treatment with their Rheumatologist. I also like to use the phrase "Functional medicine" to emphasise the improvement of an individual patient's functioning in their entire life environment.

Symptoms of Modern Society

Symptoms common to modern society consist of fatigue, malaise, sleep disturbances, headaches, myalgia, arthralgia, cognitive impairment, mood disorders, chronic unwellness, flatulence, bloating, discomfort after meals, diarrhoea, constipation and heartburn, and these symptoms often bring patients into the offices of complementary doctors. Although there are may be no sign of pathology or underlying disease in patients with these symptoms, they are also very common in patients with lupus. Fatigue, malaise, sleep disturbances, myalgia, cognitive impairment and gastrointestinal symptoms are frequent in patients with lupus, and yet may occur in the absence of an obvious disease or flare or abnormal blood tests. These symptoms are often responsive to complementary medicine.

Therapeutic Modalities of Holistic Medicine

There are many complementary modalities of therapy, here we will highlight a few. the many modalities of therapy include the use of diet nutritional supplements, including vitamins, minerals and other nutritional cofactors, and botanicals (herbal medicines). Structural modalities of therapy include chiropractice, osteopathy, and many forms of traditional physical therapy. There are also "energetic modalities" of therapy including acupuncture, homeopathy, isopathy. All of these latter modalities are predicated on the idea that a life-force exists in the body, whose proper flow throughout the body is disturbed in a disease process. These energetic modalities of therapy of therapy rebalance and harmonise the flow of life-force to promote greater health in the body.

Diet and Nutrition

The role of diet in the treatment of illness is extremely controversial in the medical profession. Conventional western medicine does not find any direct connection between diet and lupus. In complementary medicine, however, it is believed that modifying an individual patient's diet in specific ways according to his body requirements can reduce the inflammatory reactions of the body. because all material traversing the intestinal lining is inspected by the immune system, it is felt that individuals with an abnormal immune system can develop an abnormal inflammatory response on exposure to antigens in the gut. If that response were to cross react with the body's own immunologically similar tissues, an autoimmune disease may manifest. Indeed, studies have shown that patients with ankylosing spondulitis and rheumatoid arthritis do have a "leaky gut" or increased intestinal permeability. Such studies have not yet been done in lupus patients.

In Europe, some patients given an "alkalising diet" experienced a reduction of inflammation and pain. In animal models, rheumatoid arthritis is helped by fish oils. On the other hand, alfafa sprouts can cause lupus flares.

Vitamins, Minerals and Other Nutritional Cofactors

Many complementary physicians use substances such as flax seed oil, fish oils and evening primrose oil and borage seed oil, plus cofactors such as B-vitamins and magnesium to mollify the body's inflammatory reactions.

Acupuncture is best known in the western world as a modality for the treatment of pain. regular acupuncture using disposable sterile needles, as well as non-needle, painless electrical stimulation of ear acupuncture points can be effective in reducing pain in patients with lupus, and symptoms such as fatigue, malaise, insomnia and gastrointestinal problems.

Herbal Therapies

Herbs can be used as an adjunct to the treatment of lupus. For example, licorice root and ginseng are believed to support adrenal function and can help improve fatigue, not if you are not on a beta blocker. Other herbs such as cheladonium and taraxacum can support liver function, and other herbs for kidney support, intestinal function etc., are also used by complementary practioners.

ALWAYS CHECK WITH YOUR MEDICAL PRACTIONERS FOR CHEMICAL INTERACTION WITH CURRENT MEDICATIONS BEFORE TAKING HERBAL SUPPLEMENTS.

Echinacea is one of the most widely used herbs in America because of its ability to support the immune system in fighting off colds and flu. it is generally felt by complementary practioners that echinacea should NOT be used long term by lupus patients because of its immune stimulating properties. However, if a lupus patient is fighting a cold or flu, a short-term (one week) can speed the recovery. herbal preparations from other countries have sometimes found to contain sulfa, steroids or other pharmaceutical drugs. ALWAYS CHECK WITH YOUR MEDICAL DOCTOR REGARDING THE SAFETY OF ANY OVER THE COUNTER PRODUCTS.



Homeopathy

This is a vast area. Homeopathic medicines can be useful for everything from joint pain and myalgias to digestive system function in the treatment of lupus.



In Conclusion

Clinical results can be obtained using any of the above single modalities of therapy. Many practioners find that the optimal clinical results, however, are obtained by combing and integrating several modalities at the same time, individualising their use for a specific patient's unique situation. Unfortunately, thus far, no prospective double blind crossover studies have been done to prove the effectiveness of these complementary modalities in the treatment of lupus. In daily practice, however, their benefits are clinically apparent to many patients and their physicians.

This introduction has been necessarily brief. Much more can be written about each of these above modalities of therapy and their use in the treatment of patients with lupus. In choosing a complementary practioner, several things should be kept in mind.

First and foremost: what is the practioner's training and qualifications in the complementary modalities to be used on an individual patient?

Secondly, what is the practioner's experience in the treatment of other people with lupus?

Thirdly,is the practioner comfortable working with your primary rheumatologist and is your rheumatologist comfortable with a complementary practioner?

Finally, RECOGNISE THAT COMPLEMENTARY MEDICINE, UNFORTUNATELY, DOES NOT HAVE ANY MORE "CURES" THAN TRADITIONAL WESTERN MEDICINE.

The hope in seeking out complementary care is that it will serve as an adjunct and supplement to give you, the patient, additional symptomatic improvement.

However, your disease modifying medications, under the guidance of your primary rheumatologist, MUST BE CONTINUE FOR THEIR LONG-TERM BENEFIT IN YOUR TREATMENT.

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