The Lupus Book: A Guide for Patients and Their Families, Third Edition (35 page)

CAN LUPUS PATIENTS EXERCISE?

Judicious exercise is a very important part of managing lupus. It can strengthen muscles, improve flexibility, and promote a sense of well-being. Inactivity can promote osteoporosis, muscle weakness, and wasting. Patients who are not fit

are less able to respond to various stresses in the environment.

The optimal conditioning program involves engaging in activities that

strengthen muscle tone and improve endurance without putting too much stress

on a single joint. Isometric exercises, stretching exercises, and Pilates involve contracting muscles without moving the involved joint are good ways to start.

Later on, walking, swimming, or bicycling are excellent activities. To start, one can take a 5-minute walk twice a day and build up to an hour-long walk three

to five times a week. Limits of endurance are highly variable among individuals.

Table 24.2.
Herb Chart (for antiarthritics, skin treatments, and gastrointestinal treatments)
Herb

Claimed Uses

Active Ingredients

Potential Side Effects

Alfalfa

Antiarthritic

Nonprotein amino acid (L canavan-

In large quantities, could produce pancytopenia (decreased white blood

ine) and some saponins

cell count, anemia); could reactivate systematic lupus erythematosus

Arnica

Analgesic, anti-inflammatory

Sesquiterpenoid lactones (helenalin,

May cause contact dermatitis; cannot be taken internally; causes toxic

(external application)

dihydrohelenalin)

effects on the heart and increases blood pressure

Black cohosh

Antirheumatic, sore throat,

Substances that bind to estrogen re-

Information on toxicity is lacking; could cause uterine bleeding

uterine difficulties

ceptors of rat uteri; also acetin, which

causes some peripheral vasodilation

Burdock

Treatment of skin conditions

Polyacetaline compounds that have

Side effects may result from addition with belladonna

bacteriostatic and fungicidal proper-

ties

Butcher’s broom

Improve venous circulation,

Steroidal saponins (not corticoste-

Unknown; self-medication for circulatory problems is dangerous

anti-inflammatory

roids)

Calamus

Digestive aid, antispasmotic

Unknown

Use only Type 1 (North American) calamus, which is free of carcino-

for dyspepsia

genic iso a sarone (may promote cancers)

Calendula

Facilitate healing of wounds

Unknown

Unknown

(marigold)

(lacerations)

Capsicum

Counterirritant used to treat

Capsaicin (proven analgesic in

Use caution in application; avoid getting into eyes or other mucous

chronic pain (herpes zoster,

osteoarthritis, used externally)

membranes; remove from hands with vinegar

facial neuralgia, or surgical

trauma)

Catnip

Digestive, sleep aid

Cis-trans-
nepetalactone (attractive

Unknown; does not mimic marijuana when smoked

only to cats)

Chamomiles,

Aid digestion, anti-

Complex mixture of flavonoids,

Infrequent contact dermatitis and hypersensitivity reactions in suscepti-

yarrow

inflammatory, antispasmotic,

coumarins,
d
-bisabolol motricin and

ble people

anti-infective

bisabololoxides AϩB

(continued)

Table 24.2.
Herb Chart (continued)

Herb

Claimed Uses

Active Ingredients

Potential Side Effects

Chickweed

Treatment of skin disorders,

Vitamin C, various plant esters, ac-

Unknown

stomach and bowel prob-

ids, and alcohols

lems

Comfrey

General healing agent,

Atlantoin, tannin, and mucilage,

Hepatotoxicity (liver); can lead to liver failure, especially when the

stomach ulcer treatment

some vitamin B

root is eaten; also causes atropine poisoning due to mislabeling

12

Cranberry

Treatment of bladder infec-

Antiadhesion factors (fructose and

Increased calories if used in large doses (12–32 ounces per day) as a

tions

unknown polymeric compounds)

treatment rather than as a preventative (3 ounces per day)

prevent adhesion of bacteria to lin-

ing of bladder

Dandelion

Digestive, laxative, diuretic

Taraxacin (digestive), vitamin A

Free of toxicity except for contact dermatitis in people allergic to it

Devil’s claw

Antirheumatic

Har pagoside

None

DongQuai

Antispasmotic

Coumarin derivatives

Large amounts may cause photosensitivity and lead to dermatitis, pos-

sible bleeding

Echinacea

Wound healing (external),

Polysaccharides, cichoric acid, and

None reported, but allergies are possible; be sure product is pure and

immune stimulant (internal)

components of the alkamide frac-

not adulterated with prairie dock (can cause nausea, vomiting); may

tion

flare lupus

Evening

Treatment of atopic eczema,

Cis-
gamma-linoleic acid (GLA)

No data; borage seed oil (20% as GLA) may be a substitute and does

primrose

breast tenderness, arthritis

(some suggestive data)

have toxic side effects (liver toxicity, carcinogen)

Fennel

Calms stomach, promotes

Trans-
anethole, fenchone, estragole,

Do not use the volatile oil—causes skin reactions, vomiting, seizures,

burping

camphene, L-pinene

and respiratory problems, no side effects with use of seeds

Fenugreek

Calms stomach, demulcent

Unknown

None

Garlic

GI ailments, reduces blood

Allin (sulphur-containing amino

Large doses are needed (uncooked, up to 4 grams of fresh garlic a

pressure, prevents clots

acid derivative), ajoene

day), which may result in GI upsets; can ‘‘thin’’ the blood (anticoagu-

lant)

Gentian

Appetite stimulant

Glycosides and alkalids; increases

May not be well tolerated by expectant mothers or people with high

bile secretion

blood pressure (possibly increasing pressure)

Gingko biloba

Helps dementia

Antioxidant

Well tolerated

Ginseng

Adaptogen, cure-all, anti-

Triterpenoid saponins

Be sure the product is pure; some insomnia, diarrhea, and skin erup-

stress agent

tions have been reported; possible immune stimulant (antagonizes

other medications)

Goldenseal

Digestive aid, treatment of

Alkaloids (hydrastine and berberine)

In
huge
doses, may cause uterine cramps

genitourinary disorders

Honey

Sore throat, antiseptic, anti-

Fructose, glucose, sucrose, tannin

Do not give to children under 1 year of age; may cause botulism in

infective, antiarthritic,

infants

sedative

Lovage

Diurectic, promotes burping

Lactone derivatives (ph thalides)

Some photosensitivity with volatile oil of lovage

L-Tryptophan

Sleep aid, antidepressant

Essential amino acid that increases

Be sure product is pure; contaminants may cause a serious blood dis-

chemical serotonin, leading to some

order and a scleroderma-like illness

sleepiness

Mistletoe

Stimulates smooth muscle

Phoratoxia and viscotoxin (depend-

Berries are highly toxic, and the leaves may also cause cell death; in

(American), antispasmotic

ing on the plant species)

animals lowers blood pressure, weakens, constricts blood vessels

and calmative (European)

Nettle

Antirheumatic, antiasth-

Histamine, acetylcholine, 5-

Skin irritation from the active ingredients

matic, diuretic, against BPH

hydroxytryptamine

New Zealand

Antiarthritic

Amino acids, mucopolysaccharides

No toxicity or side effects except in those allergic to seafood

green-lipped

mussel

Passion flowers

Calmative, sedative

Unknown or disputed

None

(continued)

Table 24.2.
Herb Chart (continued)

Herb

Claimed Uses

Active Ingredients

Potential Side Effects

Peppermint

Calms stomach, promotes

Free menthol and esters of menthol

Do not give to infants and young children, who may choke from the

burping, antispasmotic

menthol

Pokeroot

Rheumatism, cure-all

Saponin mixture (phytolaccatoxin),

Vomiting, blood cell abnormalities, hypotension, decreased respiration,

mitogen, pokeweed mitogen (PWM)

gastritis

Rosemary

Antirheumatic, digestive,

Camphor, borneol, cineole, diosmin

Large quantities of the volatile oil taken internally cause stomach, in-

stimulant

(a flavonoid pigment)

testinal, and kidney irritation

Rue

Antispasmotic, calmative

Quinoline alkaloids, coumarin de-

Skin blisters and photosensitivity following contact; gastric upsets

rivatives

when taken internally; may be an effective antispasmotic but is too

toxic to be used

St. John’s wort

Antidepressant, anti-

10% tannin, xanthones, and flavo-

Photosensitivity dermatitis in those who take the herb for extended

(Hypericum)

inflammatory, wound heal-

noids that act as monoamine

periods; Prozac-like; increases serotonin

ing

oxidase inhibitors (antidepressants)

Sairei-to

Antiarthritic

12 herbs in combination

Diarrhea, abdominal pain, rash

Sassafras

Antispasmotic, antirheu-

Safrole

Active ingredient is carcinogenic in rats and mice

matic

Senna

Cathartic

Dianthrone glycosides (sennosides

Diarrhea, gastric and intestinal irritation with large and/or habitual

AϩB)

doses

Tea tree oil

Antiseptic (external applica-

Terpene hydrocarbons, oxygenated

No side effects except skin irritation in sensitive individuals

tion only)

terpenes (terpinen-4-ol)

Valerian (garden

Tranquilizer, calmative

Unknown

None noted

heliotrope)

Yucca

Antiarthritic

Saporins

None noted

Source:
Compiled by Elaine E. Furst, R.N., and Daniel E. Furst, M.D. Modified from V. E. Taylor:
The Honest Herbalist, 3rd ed,
Binghamton, NY: Haworth Press, 1993, pp. 336–351.

How to Treat Lupus with Physical Measures

[191]

The ‘‘talk test’’ asks: Can you talk comfortably while exercising? If not, it’s best to slow down or stop. Also, one should
never
exercise beyond the point of minimal discomfort.

When a joint or muscle is painful, local heat can be applied. Moist heat (e.g., shower, bath, hot tub, jacuzzi, thermophore) is superior to dry heat. If an area is acutely injured, the application of ice will minimize swelling during the first 36 hours. Inflamed joints must not be exercised. This can be harmful. For example, engaging in such activities as tennis, bowling, golf, weight lifting, or rowing with an inflamed or swollen hand, wrist, or shoulder can aggravate the

disease process. But the injured area should not be ignored completely. An

inflamed joint should be put through its full range of motion several times a

day. This helps prevent contractures and muscle atrophy.

WOULD A REHABILITATION PROGRAM HELP?

As discussed in Chapter 13, the inflammatory arthritis of lupus causes visible

swelling of the joints in 20 to 30 percent of patients with the disease and de-

formities in less than 10 percent. Patients with inflammatory arthritis often benefit from a formal rehabilitation program.

Physical therapists
are licensed allied health professionals (look for RPT, registered physical therapist, after the name). They help improve conditioning, instruct you on how to move inflamed joints without damaging them, and will

introduce you to muscle-strengthening regimens. They can also apply hot packs,

administer ultrasound, give gentle massages, and employ spray-and-stretch tech-

niques (using a coolant spray followed by gentle tissue stretching) for tender

fibrositic tissues. A RPT will be glad to suggest a conditioning program to your doctor.

Occupational therapists
work with physical therapists. They are also licensed allied health professionals and provide valuable, underutilized expertise (look for OTR, registered occupational therapist, after the name). They will perform

an ‘‘Activities of Daily Living’’ (ADL) evaluation. After examining what an

individual does in the course of a day at work and at home, the therapist can

suggest methods of energy conservation and joint protection. In other words, is there a way to cook a meal or get on or off a toilet seat with the least amount of stress on an inflamed or damaged joint, which can also minimize discomfort?