Managing Mood Swings and Infections in SLE Patients: A Guide

The SLE patient became manic and developed an abscess on the buttocks after changing medication?

Hello Doctor: I am a patient with Systemic Lupus Erythematosus (SLE), currently experiencing stage three nephritis and recurrent vasculitis of the skin.
My current medications include two tablets of Mycophenolate Mofetil daily, three tablets of Methotrexate, and one tablet of Folic Acid (once a week).
I also take two tablets of Quinine and two tablets of steroids daily.
Recently, the vasculitis in my limbs has worsened, and I have developed abscesses on my buttocks and thighs (red, swollen, and painful; I have had one drainage procedure done by a dermatologist).
Could this be due to a decrease in my immune function from the medications, making me more susceptible to infections? Additionally, since starting Mycophenolate Mofetil, Methotrexate, and Folic Acid, I have experienced fewer fevers and less joint pain, but my emotions have become very unstable, and I often feel anxious with restless limbs.
Should I discuss adjusting my medications with my doctor or consider consulting a psychiatrist?

Zhao, 20~29 year old female. Ask Date: 2024/03/29

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
The susceptibility to skin infections is indeed related to the current use of immunosuppressants.
You may ask your physician to gradually taper your medication based on your condition.
Additionally, it is important to protect your skin from injury and scratching, as this can help reduce such occurrences.
I also recommend incorporating exercise into your routine, as it can further alleviate joint pain, promote local circulation, and decrease the chances of recurrent skin inflammation and abscess formation.
Regarding the shaking of your hands and feet, please discuss this with your rheumatologist, and if necessary, further examinations can be conducted.
As for emotional aspects, sometimes exercise can help alleviate these feelings, and it may not be significantly related to your current medications.
If needed, you may consider consulting a psychiatrist.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is here to support you.

Reply Date: 2024/03/29

More Info

Managing mood swings and infections in patients with Systemic Lupus Erythematosus (SLE) can be quite challenging due to the complex interplay between the disease itself, the medications used for treatment, and the psychological impact of living with a chronic illness.
Firstly, it’s important to understand that SLE is an autoimmune disease that can affect multiple organ systems, including the skin and kidneys, as you mentioned with your current conditions of renal involvement and recurrent vasculitis. The medications you are taking, including immunosuppressants like mycophenolate mofetil (睦體康) and steroids, are crucial for managing SLE but can also lead to increased susceptibility to infections. This is because these medications work by dampening the immune response, which is necessary to control the autoimmune activity but can also leave you more vulnerable to infections, such as the abscesses you are experiencing in your buttocks and thighs.

The development of these abscesses, particularly in the context of immunosuppressive therapy, suggests that your immune system may not be functioning optimally. It is essential to monitor any signs of infection closely, including redness, swelling, pain, and fever. If you notice these symptoms, it is crucial to seek medical attention promptly, as early intervention can prevent complications. Your dermatologist's decision to drain the abscess was appropriate, and you should follow up with them to ensure proper healing and management of any further infections.

Regarding your mood swings and feelings of anxiety, these can be common in patients with chronic illnesses like SLE. The stress of managing a chronic condition, coupled with the side effects of medications, can significantly impact mental health. The medications you are taking, particularly steroids, can also contribute to mood changes, including irritability and anxiety. It is not uncommon for patients on corticosteroids to experience mood swings, and these can sometimes be mistaken for underlying psychiatric conditions.

Given your symptoms of increased anxiety and restlessness, it would be beneficial to discuss these changes with your healthcare provider. They may consider adjusting your medication regimen or referring you to a mental health professional for further evaluation. Cognitive-behavioral therapy (CBT) and other forms of psychotherapy can be very effective in managing anxiety and mood disorders, especially in the context of chronic illness.

In addition to medication adjustments, lifestyle modifications can also play a significant role in managing mood swings. Regular physical activity, a balanced diet, and adequate sleep are all essential for maintaining both physical and mental health. Mindfulness practices, such as meditation or yoga, can also help in managing stress and improving emotional regulation.

In summary, managing SLE involves a multifaceted approach that includes careful monitoring of infections, potential medication adjustments, and addressing mental health concerns. It is crucial to maintain open communication with your healthcare team, including your rheumatologist and any mental health professionals, to ensure a comprehensive approach to your care. Regular follow-ups and proactive management of both physical and emotional symptoms can significantly improve your quality of life.

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