Treatment of Lupus
Causes | Symptoms | Types | Testing | Treatment | Other Illnesses | Quality of Life
How is lupus treated?
There is no cure for lupus at the present time, but there are effective treatments. These treatments can reduce symptoms and prevent complications, allowing people with lupus to lead active lives.
Treatment must be individualized. That means making a treatment plan based on what symptoms an individual has, how severe they can be, the individual's age and other lifestyle factors. Treatment changes over time. Patients should work closely with the lupus team. Even very young people with lupus can take an active role in managing their disease.
Medications may be used to:
- Reduce swelling and pain
- Decrease signs and symptoms of lupus
- Prevent or reduce flares
- Calm the immune system
- Reduce or prevent damage to joints
What types of medications are used?
Corticosteroids are the most commonly used treatment for lupus and most signs of lupus respond rapidly to the treatment. These medications are related to a natural anti-inflammatory hormone known as cortisol and work by rapidly suppressing inflammation. They are also highly effective in relieving joint and muscle pain and fatigue. Corticosteroids are very powerful and in high doses can suppress the body's immune system. For this reason, corticosteroids are usually prescribed in the lowest possible doses. Currently used corticosteroids include prednisone (Deltasone", Orasone") and methylprednisolone (Medrol").
Corticosteroids may be taken in a number of ways. Creams or ointments containing corticosteroids may be applied to lupus skin rashes. Corticosteroids may be taken by mouth as pills. These should be taken at the same time each morning because natural cortisol levels peak in the morning. Taking pills with food or milk can decrease stomach upset. Higher doses (boluses) of corticosteroids may be injected into the vein (intravenous or IV). This is known as pulse or bolus therapy and is used to help control lupus flares. IV doses are usually given several times over the course of a month at a doctor's office or hospital. Once the flare is over, the patient can go back to using corticosteroid cream or pills.
Side effects vary with the form of corticosteroid used. Creams and ointments can cause the skin to thin and discolor. Pills can cause facial swelling, increased appetite and weight gain, mood changes, acne, facial hair, osteoporosis (thinning or weakening of the bones), high blood pressure, muscle weakness, diabetes, glaucoma and cataracts. Because of the possibility of cataracts, people taking oral corticosteroids should have eye exams for cataracts every year and report any vision problems to their lupus healthcare team. Corticosteroids given by injection can lead to infections, nervousness, and a metallic taste in the mouth.
While the side effects of corticosteroids can be serious, they generally stop when the medication is no longer used. It is important to take the medication exactly as prescribed. Never stop taking medication without consulting a physician and always follow the doctor's directions on how to taper off corticosteroids. The adrenal glands, small glands that sit on top of the kidneys, normally make small amounts of the natural anti-inflammatory glucocorticoid called cortisol. Taking corticosteroid medication can cause the body to slow down or stop production of natural cortisol made in the body. So stopping corticosteroids suddenly would leave the patient in worse shape than before, without either the natural or the drug form of corticosteroids. This condition is known as adrenal insufficiency and can cause weakness, fatigue, fever, weight loss, vomiting, and diarrhea. Patients on corticosteroids for more than one week cannot discontinue corticosteroid therapy abruptly.
Nonsteroidal anti-inflammatory drugs (NSAIDS) may be used alone or combined with other types of drugs to control pain, inflammation, and fever. NSAIDS include over-the-counter medications like aspirin, ibuprofen, and naproxen, as well as prescription drugs.
Common side effects of NSAIDS include stomach upset, diarrhea, and fluid retention. Less common side effects are liver, kidney, and neurological complications.
NSAIDS are taken by mouth and should be taken with food or milk to decrease stomach irritation.
Antimalarials are drugs developed to treat malaria and are now used to treat some symptoms of lupus. These drugs are very effective in controlling the fatigue, joint pain, skin rashes, mouth ulcers, and lung inflammation associated with lupus. Antimalarials are also very good drugs to use to avoid disease flares. The most common antimalarials used are hydroxychloroquine sulfate (Plaquenil") and chloroquine (Aralen").
Side effects can include stomach upset, diarrhea, vomiting, headache, nervousness, dizziness, muscle weakness, and rarely eye damage. People being treated with antimalarials should have their eyes examined thoroughly before beginning treatment and then have eye exams every 6 months.
Antimalarials are taken by mouth and should be taken before or after meals at the same time each day to maintain drug levels.
Immunosuppressives restrain an overactive immune system by blocking the production or function of immune cells. These drugs are generally reserved for people with lupus that involves the kidneys or central nervous system. Immunosupressives may also be used to reduce or sometimes eliminate the need for taking corticosteroids. This spares patients from the side effects of corticosteroids and is known as steroid-sparing.
Side effects may include nausea, vomiting, bladder problems, decreased fertility, and hair loss. Immunosuppressives also increase risk of infection and cancer, even though some immunosuppressives are approved to treat cancer.
Immunosuppressives may be taken by mouth or intravenously at a hospital or infusion center.
The major immunosuppressive drugs used to treat lupus are listed below.
- Cyclophosphamide (Cytoxan") targets and causes damage to cells that produce autoantibodies. These cells and antibodies lead to pain, inflammation, and other symptoms of lupus. Cyclophosphamide is also used to treat several types of cancer.
- Rituximab (Rituxan") works by lowering the number of B cells, white blood cells that are overactive in people with lupus and produce autoantibodies. Research shows that rituximab reduces symptoms of lupus, but the drug is still experimental. More studies are needed to test if rituximab is safe and effective for treating lupus. Rituximab has been approved for treating cancer of the lymph system.
- Mycophenolate mofetil (Cellcept") can slow down the immune system in people with lupus. It is sometimes used as an alternative to cyclophosphamide for patients with inflammation that threatens internal organs such as the kidneys. Mycophenolate is steroid-sparing and was developed to suppress the immune system in people receiving organ transplants so that the transplants would not be rejected.
- Azathioprine (Imuran") inhibits the production of immune cells. It is steroid-sparing and is used in patients with lupus who have damaged kidneys or other organs, muscle inflammation, or advanced arthritis. The drug helps reduce symptoms and damage to organs and can also help to better control lupus. Azathioprine is mainly used to prevent organ rejection in patients receiving transplants.
Intravenous immunoglobulins (IVIGs) are blood proteins that act as antibodies. These proteins have been pooled from several thousand blood donors who have been carefully screened for blood-borne diseases. IVIGs may be used to control lupus that involves a body organ or causes inflammation of a blood or lymph vessel. There is no clear understanding of how IVIGs work. They are thought to reduce antibody production or help clear immune complexes from the body.
Side effects include a rash or mild skin reaction at the IV area, nausea and vomiting, chills and headache.
Cyclophosphamide, rituximab and IVIGs must be given intravenously in a hospital or infusion center and patients must be monitored closely to minimize side effects and maximize results.
Written 12/07
