If you are taking an immunosuppressive drug that may suppress the bone marrow, regular blood tests must be done to monitor your blood cell levels. Because the risk of infection is higher when you are taking an immunosuppressive, it is important to notify your doctor if you develop a fever or any other new symptoms that might suggest an infection (e.g. cough). Some believe that immunosuppressive drugs may increase the risk of certain cancers. The most common problem is a precancerous abnormality that, if undetected, could lead to cervical cancer. In fact, this condition is quite common even in women without lupus. For this reason, regular gynecological check-ups with Pap Smear testing are recommended for all women, and are especially important for women with lupus. Fortunately, with regular checks (Pap Smears) to ensure that there is no precancerous changes in the cervix, the more serious consequences related to cervical cancer can be avoided, even if you take immunosuppressive drugs. Other cancers that are more common in people with lupus are lymphoma and lung cancer. However, there is no clear evidence that this increased risk is primarily caused by drug exposures. Though some lymphomas may be related to medication use, research suggests that lymphoma risk may also be increased by uncontrolled lupus. It is important to know that, though they occur more often in people who have lupus than in the general population, lymphomas still only arise in a very small number of people with lupus. Thus, when they are required to control lupus, the benefits of immune suppressive drugs are generally believed to outweigh the risks. Finally, don’t forget that some of the greatest risk factors for cancer are ones that you can modify. These risk factors include smoking, a high-fat diet and obesity. Paying attention to these factors (especially quitting smoking) is the best cancer-preventing strategy that you can take. Types of immunosuppressive drugs Various types of immunosuppressive drugs are available to treat lupus. Although they have different mechanisms of action, each drug works to decrease the body’s over-active immune response. It is important that you understand exactly how and when to take your medications, and what the potential side effects are. You need to work with your doctor to make sure that the dosage delivers benefits with as few side effects as possible. The effects of these drugs build up gradually, so you may not notice the benefits for several months. Most drugs used in SLE were not developed for SLE, and thus are used ‘off label’, meaning that the drugs are used by lupus experts to treat the disease, even though these drugs were not designed or formally approved for use in SLE. However, these are the immunosuppressive drugs most frequently used in the treatment of SLE: Azathioprine (Imuran®): One of the most widely used immunosuppressive drugs for lupus, azathioprine, works by blocking immune cell function. Side effects can include nausea, lowered blood cell counts, and liver inflammation. If you are receiving this drug, you should have regular blood tests to determine that your cell counts and liver remain normal. If the tests indicate a problem, your doctor will adjust the drug dose. 56