Lupus is an autoimmune disease where the immune system attacks healthy tissue, causing inflammation and damage to various parts of the body. There is no cure for lupus, but there are treatments that can help control symptoms and prevent flares. Determining the most effective treatment depends on the individual and the manifestations of their disease. Some of the most commonly used medications and therapies include:
Antimalarials
Antimalarials such as hydroxychloroquine (Plaquenil) are often used as first-line treatments for lupus. These medications can help control joint pain, rash, and inflammation. They may also help prevent disease flares and organ damage. Studies show antimalarials can reduce mortality rates in lupus patients.
Corticosteroids
Corticosteroids such as prednisone are effective at quickly reducing inflammation and preventing damage from acute lupus flares. Because of their strong immune-suppressing effects, steroids are usually prescribed in the lowest doses and for short periods to minimize side effects.
Immunosuppressants
Medications that suppress the immune system, like azathioprine, mycophenolate, and methotrexate, are commonly used to control lupus when other treatments have failed. They help reduce pain, rashes, and prevent flares and organ damage. Immunosuppressants can have significant side effects so require close monitoring.
Biologic Drugs
Newer biologic drugs like belimumab (Benlysta) target specific parts of the immune system. Belimumab reduces autoantibody levels and helps prevent lupus flares. These drugs may be less toxic than traditional immunosuppressants. However, they are expensive and don’t work for everyone.
NSAIDs
Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen can help relieve joint pain, swelling, and fever caused by lupus. NSAIDs do not treat the underlying disease so are used for symptom management. Long-term NSAID use carries risks of stomach ulcers, bleeding, kidney and heart problems.
Complementary Therapies
Complementary approaches like acupuncture, massage, meditation, and tai chi may help some lupus patients manage pain, reduce stress, and cope with their disease. However, these therapies should not replace standard medical treatments. Communicating with your health providers about complementary approaches is important.
What factors determine the most effective lupus treatment?
There are several factors physicians consider when determining the best lupus treatment plan:
Type of Lupus
The four types of lupus (systemic, discoid, drug-induced, neonatal) cause different symptoms that may require specific treatments. For example, topical creams are first-line for discoid lupus rashes, while systemic lupus requires systemic medications.
Disease Severity
Mild lupus may be managed with antimalarials and NSAIDs, while severe disease requires stronger immune-suppressing drugs. Doctors assess factors like antibody levels, organ involvement, and frequency of flares to gauge severity.
Location of Symptoms
Where symptoms manifest influences treatment. For example, lupus nephritis (kidney inflammation) warrants immunosuppressants, while CNS involvement requires corticosteroids. The treatment has to target the affected body system.
Side Effects
The risk of medication side effects is weighed against benefits. Younger lupus patients, for example, avoid long-term steroid use to prevent osteoporosis, weight gain, and diabetes. Individual risk factors like age, comorbidities, and lifestyle are considered.
Response to Treatment
If a medication is not adequately controlling symptoms, the physician may increase the dosage, add or switch to another drug. Finding the right treatment can take time and adjustments. Close monitoring and open communication with your doctor is key.
Cost of Medications
Many lupus drugs are expensive. Insurance coverage, co-pays, and affordability may limit treatment options. Doctors try to find effective medications that are reasonably priced and fit the patient’s budget.
Adherence
The ability to follow a treatment regimen impacts its effectiveness. Doctors consider the ease of administration (oral, injection), frequency of doses, and potential barriers for the individual patient that could affect adherence.
What are the most common medications used to treat lupus?
The medications most often prescribed to treat lupus are:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs like ibuprofen (Advil), naproxen (Aleve), and celecoxib (Celebrex) help relieve pain, swelling, and fever associated with lupus. They do not treat the disease itself. NSAIDs can be hard on the stomach so should be taken with food.
Antimalarials
Hydroxychloroquine (Plaquenil) is the most commonly prescribed antimalarial for lupus. It helps minimize flare-ups, controls joint swelling and pain, and prevents organ damage. It can take several weeks to notice effects. Side effects are generally mild including stomach upset and rarely vision changes or muscle weakness.
Corticosteroids
Prednisone is a steroid often used short-term to rapidly reduce inflammation caused by serious lupus flares. Long-term prednisone use leads to serious side effects so tapered doses are advised once a flare subsides to avoid dependence. Other steroid options include methylprednisolone and dexamethasone.
Immunosuppressants
Immunosuppressants like methotrexate, mycophenolate mofetil (CellCept), azathioprine (Imuran), cyclosporine and cyclophosphamide (Cytoxan) dampen an overactive immune system. They are used for more serious cases of lupus and prevention of organ damage. Side effects vary for each drug but include increased infections, nausea, liver damage, decreased white blood cell count, and infertility.
Biologics
Belimumab (Benlysta) is currently the only FDA-approved biologic for treating systemic lupus erythematosus (SLE). The drug reduces autoantibody levels and helps prevent flares. It is given by intravenous infusion. Headaches, nausea, and fever can sometimes occur.
What are the side effects of common lupus medications?
The main categories of medications used to treat lupus and their potential side effects include:
NSAIDs
- Stomach ulcers or bleeding
- Kidney problems
- Increased blood pressure
- Fluid retention
- Rash
- Ringing in the ears (tinnitus)
Antimalarials (hydroxychloroquine)
- Headache
- Dizziness
- Stomach cramps
- Diarrhea
- Vision changes (rare)
- Muscle weakness (rare)
Corticosteroids (prednisone)
- Insomnia
- Increased appetite
- Weight gain
- Fluid retention
- High blood pressure
- Bone loss (osteoporosis)
- Mood changes
- High blood sugar
- Cataracts
- Susceptibility to infection
Immunosuppressants
- Nausea
- Vomiting
- Diarrhea
- Rash
- Increased infections
- Liver damage (azathioprine)
- Kidney problems (cyclosporine)
- Infertility
- Bone marrow suppression
Biologics (belimumab)
- Nausea
- Diarrhea
- Fever
- Fatigue
- Headache
- Low white blood cell count
What are the most effective non-medication treatments for lupus?
In addition to medications, many non-drug therapies can effectively help manage lupus symptoms:
Sun Protection
Sun exposure exacerbates lupus rashes and joint pain. Using broad-spectrum sunscreen of SPF 30 or higher, protective clothing, and avoiding peak sun hours can prevent flares.
Cardiovascular Exercise
Low to moderate intensity cardiovascular exercise like walking, swimming, stationary cycling 3-4 times a week helps improve stamina, joint pain, and prevent cardiovascular disease common in lupus patients.
Healthy Diet
Eating a balanced diet high in fruits, vegetables, lean protein, whole grains, and omega-3 fatty acids may help manage lupus symptoms. Anti-inflammatory foods are best. Limiting alcohol intake is also advised.
Stress Reduction
Managing stress with techniques like psychotherapy, support groups, deep breathing, yoga, tai chi, meditation, journaling, or music therapy helps control lupus flares triggered by stress.
Acupuncture
Acupuncture performed by a licensed practitioner may relieve some lupus joint and muscle pain, headaches, and fatigue. More research is needed on its efficacy.
Physical & Occupational Therapy
PT and OT can help improve mobility, strength, coordination, range of motion, and ability to perform day-to-day tasks limited by fatigue or joint pain.
What are potential complications of lupus?
Some of the most common complications that can arise from lupus and its treatment include:
Cardiovascular disease
Having lupus doubles the risk of cardiovascular events like heart attack or stroke. Steroid medications can also increase this risk. Patients should be monitored closely for high blood pressure, cholesterol, and heart problems.
Kidney disease (lupus nephritis)
Up to 60% of lupus patients develop inflammation of the kidneys. This can lead to serious complications like kidney failure, dialysis, and end stage renal disease. Immunosuppressants and steroids help prevent permanent damage.
Pregnancy complications
Women with lupus have higher rates of miscarriage, preeclampsia, preterm birth, and stillbirth. Lupus flares are also more common after delivery. Doctors monitor pregnancies closely and time deliveries at the optimal point for health of the mother and baby.
Infections
Many lupus medications suppress the immune system, making patients prone to common and opportunistic infections. Flu and pneumonia vaccines are critical preventative measures.
Osteoporosis
Bone loss from long-term steroid use or the disease itself increases risk of osteoporosis and fractures. Regular bone density screening, calcium supplements, vitamin D, and treatment with bisphosphonates helps strengthen bones.
psychiatric disorders
Depression and anxiety are more common in lupus patients. Talk therapy, support groups, and at times medication can help manage these conditions that negatively impact quality of life.
What is the long-term outlook for people with lupus?
The long-term outlook for lupus varies substantially depending on the severity of disease and organs involved. With modern treatments, most patients with lupus can live a normal lifespan. Overall, studies show 5-15 year survival rates are:
- 92% for patients with only skin lupus (discoid)
- 90% for general lupus population
- 78% for those with major organ involvement (e.g. kidney, brain, lungs)
Poor prognostic factors include:
- Male gender
- Early onset of lupus (childhood)
- Kidney disease
- Serositis (inflammation of organs like heart, lungs, liver)
- Neurologic disorders
- Hemolytic anemia
The most common causes of death are related to:
- Cardiovascular disease due to accelerated atherosclerosis
- Infections due to immunosuppressant medications
- Kidney complications
- Malignancies due to immune dysfunction
With proactive monitoring and care of complications through a coordinated team of rheumatologists, nephrologists, cardiologists and primary care providers, many patients can now live relatively normal lifespans and good quality of life.
Conclusion
Lupus is a chronic autoimmune condition that can be effectively managed with modern medications and lifestyle approaches. Hydroxychloroquine and steroids remain the cornerstones of therapy for most patients to minimize flares and prevent organ damage. More potent immunosuppressive drugs may be required for those with major organ system involvement. While there is no cure for lupus, early diagnosis and active monitoring and treatment of complications can enable patients to live a relatively normal lifespan. Research continues for safer, more targeted therapies that can induce permanent remission for this disease. With the support of a caring multidisciplinary medical team, patients with lupus can learn to cope with their disease successfully.
