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I Have a relative 43, with SLE who is taking hydroxychloroquine after 2 years on immunosuppressants following a terminal diagnosis for Chronic (Fibrotic) Lupus Pneumonitis with 80% loss of lung capacity in one lung and about 30% in the other lung. She also had rheumatic joint symptoms and can have flare ups. She is now stable and her symptoms are minimal with the HCQ and she has found out that she is pregnant (7wks). She has been advised that as long as her SLE doesn’t flare up she could carry to term. However, if her immune system overacts due to the hormonal changes she will have to abort. She is generally feeling good, has good energy, decent sleep. She has been having some hot flushes at night and now has moderate morning sickness, with desire for simple carbs and salt and little liquid. She is already avoiding nightshades, wheat, and dairy and eating a mainly healthy, unprocessed diet. Please can you advise what immunomodulators are safe to use in pregnancy to help her maintain her health so she can carry to term? Any other advice of appropriate supplementation considering her needs? Thanks.
There are several factors to consider here. The most important is to address the unique needs of each person as clearly as possible. If blood sugar is an issue, the insulin elevation will tend to inhibit vagal motor outflow. If that occurs, the anti-inflammatory influence of the vagus nerve on GI and spleen function (inhibition of TNFalpha) and on liver function (inhibition of IL-6) will be diminished.
I would make sure that a functional medicine ob/gyn is on board, to vet supplement choices during pregnancy. If one is not available locally, I would find one somewhere, contact them and ask for a consult.
It’s always useful to remember that autoimmune diseases are not categorizable as Th2 or other T cell dominance based diseases. That is an older view.
Generally, instigation of flare activation is driven by Th17 cell activation. The two main inhibitors of Th17 are Tregs and Th1 cells. One concern about the ongoing use of steroids is that steroids induce apoptosis (programmed cell death) of Th1 cells, so that may not be entirely suitable. If steroids must be used (and there are situations where that’s appropriate), offsetting the Th2 dominance induction caused by loss of Th1 cell activation is a useful thing to consider.Lastly, it’s key to remember that prolactin is a major promoter of autoimmune activation. Prolactin levels will climb normally, to induce lactation, which is appropriate. That will likely push the patient toward flare activation. Take measures to push back against this.
Glutathione and NAC, in robust doses, 500mg liposomal gsh bid, 900mg NAC bid, would be useful to push back against any further lung damage. Perilla, astragalus, NAC, quercetin, often given together, are useful to push back against the Th2 dominance likely to be sparked by the lung dysfunction.
This is all the info I can share and do advise she sees a holistic practitioner who can help.
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