Lupus Treatment: Medications and Complementary Therapies

If you or a loved one has been diagnosed with the autoimmune disease systemic lupus erythematosus (SLE) or any of the less common subtypes of lupus, you may be wondering about available treatment options and which ones may be right for you.

Because lupus is a chronic disease, doctors work with you to manage symptoms — which can range from mild arthritis and rash to problems with the kidneys and other organs — using a variety of medicines and therapies. And the best treatment approach for you might change over time as your symptoms and the condition change.

“My message to patients is that we can do an excellent job of managing the condition compared to 20 years ago,” says Roberto Caricchio, MD, the division chief of rheumatology at UMass Memorial Medical Center in Worcester, Massachusetts.

That said, people should never underestimate the serious effects lupus can have, he adds, which is why working with your doctor to manage the condition is so important.

Because lupus symptoms and severity vary among patients, treatment with lupus medication is different for each patient, too, says Neil Kramer, MD, a rheumatologist at Overlook Medical Center in Summit, New Jersey. Patients may receive one or more of the following drugs:

Hydroxychloroquine

HCL (Plaquenil) helps prevent lupus flares, minimizes joint inflammation, and controls fever, fatigue, pleurisy (inflammation of the sac surrounding the lungs), and pericarditis (inflammation of the lining around the heart). The drug is also “the backbone of therapy” for most skin rashes associated with lupus, says Kramer. Mouth sores may also be alleviated with this drug.

Corticosteroids

Doctors may prescribe a low-dose corticosteroid, such as prednisone (Deltasone), for short-term symptom control.

Corticosteroids may also be used to get rid of lupus flares, or the appearance of symptoms after a period of remission, says Francis Luk, MD, a rheumatologist at AdventHealth in Hendersonville, North Carolina. “Depending on severity and type of flare and how many flares the patient has recently experienced, rheumatologists may adjust medications,” he adds.

Immunosuppressants

When lupus starts affecting other organs of the body, doctors often prescribe drugs that suppress the immune system, says Kramer. (Lupus causes the body’s immune system to mistakenly attack itself. Immunosuppressive medication helps stop that from happening.)

In addition to helping with lupus nephritis, these drugs may be prescribed to reduce inflammation of the heart and the lining surrounding the lungs. Disease-modifying antirheumatic drugs (DMARDs) used to treat rheumatoid arthritis, such as methotrexate (Trexall), may be an effective and well-tolerated option for reducing swelling in patients with severe arthritis, adds Caricchio. DMARDs are another type of immunosuppressant.

Targeted Therapy

Belimumab was the first medication to gain approval for the treatment of SLE in the past 50 years. It has been helpful in limiting the use of prednisone and in helping avoid severe flares of the illness, says Kramer.

Nonsteroidal Anti-Inflammatory Drugs

Treatment for Lupus Rash

In addition to the oral antimalarial hydroxychloroquine, doctors may prescribe topical steroids for lupus rash.

Rheumatologists need to see patients regularly to monitor and help manage treatment side effects with physical exams and laboratory tests, says Stacy Ardoin, MD, a rheumatologist at The Ohio State University Rheumatology Clinic and at The Ohio State University Lupus Clinic in Columbus.

For example, NSAIDs can cause side effects like stomach bleeding or kidney damage, while antimalarials can cause mild and temporary side effects, such as stomach upset and changes in skin color. Damage to the back of the eye, or retina, may also occur, so regular eye exams may be necessary.

Additionally, immunosuppressive medication used to treat lupus can raise the risk of infection, says Dr. Ardoin. Other side effects of these drugs are nausea, vomiting, diarrhea, hair loss, and high blood pressure.

Steroids can also raise the risk of osteoporosis, as well as heart disease, heart attack, congestive heart failure, and stroke, says Ardoin. Belimumab can also suppress the immune system with side effects including serious infections, infusion reactions, headache, nausea, and fatigue.

Regular visits allow your rheumatologist to make sure the medication you’re taking is helping with the symptoms it should be helping with — and to make sure the drugs aren’t causing any side effects that could be problematic.

Your provider will choose the therapy that’s best for you based on your symptoms and the side effect profile of the medications. Make sure to also have a thorough discussion of your lupus treatment options not only with your rheumatologist but also with your dermatologist (skin doctor) and nephrologist (kidney doctor) if needed, as many doctors can manage the various lupus symptoms. If there are any problems or changes, your care team can adjust your treatment plan as they see fit.

In addition to prescribing medication, doctors may also recommend lifestyle changes to help manage lupus. These may include avoiding sun exposure and paying closer attention to stress management to prevent lupus flares. People with lupus should also avoid smoking to help with heart and lung health, Kramer says.

A healthy diet and getting enough exercise are also encouraged to help manage cardiovascular disease risk, Ardoin says.

• Since lupus can present differently in each individual, treatment may vary by patient.
• That said, current guidelines suggest HCL should be the backbone of lupus treatment for most patients alongside lifestyle interventions.
• Corticosteroids can help manage active inflammation and flares but should not be used as part of a long-term treatment plan because of their unwelcome side effects.
• Check in with your rheumatologist regularly to make sure your treatment plan is helping with your symptoms. If not, they can adjust your medication accordingly.