Lupus Treatment: Medications and Lifestyle Changes That Can Help
If you or a loved one has been diagnosed with the autoimmune disease systemic lupus erythematosus 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 medications and therapies. And the best treatment approach for you might change over time as your symptoms and the condition changes.
Generally, with the help of a rheumatologist, up to 90 percent people with lupus have a normal life expectancy, according to the Lupus Foundation of America. (1)
“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 interim section chief of rheumatology at Temple University Hospital in Philadelphia and the director of the Temple Lupus Clinic at the Lewis Katz School of Medicine. With 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.
Common Drugs and Medications Used to Treat Lupus
Because lupus symptoms and severity are different in each patient, treatment is different in patients, too, says Neil Kramer, MD, the co-medical director at the institute for rheumatic and autoimmune diseases at Overlook Medical Center in Summit, New Jersey. Patients may receive one or more of the following medications:
Nonsteroidal Anti-inflammatory Drugs
Some patients with mild lupus, with a little joint pain or rash can be managed with anti-inflammatory drugs such as nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen or naproxen, says Stuart D. Kaplan, MD, the chief of rheumatology at South Nassau Communities Hospital in Oceanside, New York. These drugs can also help manage fever and inflammation of the heart and lining around the lungs. (2)
Most patients with systemic lupus erythematosus (unless they’re otherwise advised by their rheumatologist) should be taking an oral antimalarial drug — medications originally used to prevent a malaria infection, but that have been found to help with lupus symptoms, says Dr. Kramer. The antimalarial hydroxychloroquine 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. Chloroquine and quinacrine are other antimalarials drugs used to treat lupus. (3)
Doctors may prescribe a low-dose corticosteroid such as prednisone to reduce inflammation in patients whose symptoms are not well controlled with antimalarials, says Kramer. Patients with inflammation of the kidneys, lungs, or heart, or who have central nervous system symptoms, may benefit from treatment with high-dose corticosteroids.
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, an assistant professor of rheumatology and immunology at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. “Depending on severity and type of flare and how many flares the patient has recently experienced, rheumatologists may adjust medications,” he adds.
Corticosteroids are usually taken as a pill. They are sometimes prescribed as a topical cream for skin rash associated with lupus. (4) Long-term steroid use, however, has multiple systemic side effects, so physicians try to minimize the use of steroids if possible.
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 medications help stop that from happening.) One such example, is Cytoxan (cyclophosphamide), originally an anticancer drug. It suppresses the immune system and may be used to reduce inflammation of the kidney, or nephritis, says Dr. Kaplan.
If cyclophosphamide doesn’t work for patients with lupus nephritis, they now have the option of trying another drug, and more options are being tested in clinical trials, says Dr. Caricchio. For example, doctors may use CellCept (mycophenolate mofetil), Imuran (azathioprine), or Restasis (cyclosporine). Prograf (tacrolimus) may also be an effective option for lupus nephritis, according to study data appearing in the January 2016 edition of Autoimmunity Reviews. (5)
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 for rheumatoid arthritis treatment, such as methotrexate, may be an effective and well-tolerated option for reducing swelling in patients with severe arthritis, adds Caricchio. DMARDs are another type of immunosuppressant.
If NSAIDs, antimalarials, and other drugs don’t provide enough symptom relief, doctors may prescribe the drug Benlysta (belimumab), which is given by injection or infusion. It lowers levels of autoantibodies, or the antibodies that target the body’s own cells and tissues. (6)
Belimumab is the first medication to gain approval for the treatment of systemic lupus erythematosus in the past 50 years and has been helpful in limiting the use of prednisone and in helping avoid severe flares of the illness, says Kramer. It is given by infusion.
Another targeted treatment, anifrolumab, is being investigated in clinical trials and appears to be promising, says Stacy Ardoin, MD, a rheumatologist at the Ohio State University Wexner Medical Center in Columbus, citing a study in the February 2017 issue of Arthritis & Rheumatology (7). “I don’t think it will work for everyone, but it’s good to have another treatment option.”
Treatment for Lupus Rash
In addition to the oral antimalarial hydroxychloroquine, doctors may prescribe topical steroids for lupus rash. Steroids or antimalarials may also be injected directly into rash lesions. (8) Topical creams containing tacrolimus or pimecrolimus that modulate the skin’s immune response may help manage lupus rash. Oral thalidomide, which affects the immune response, may be prescribed if other therapies don’t work. Doctors may also recommend that people with lupus rash avoid the sun and other ultraviolet light sources and wear sunscreen.
Why Monitoring Drug Side Effects Is Important If You Have Lupus
Rheumatologists need to see patients regularly to monitor and help manage treatment side effects with physical exams and laboratory tests, says Dr. Ardoin.
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 medications used to treat lupus can raise the risk of infection, says Ardoin. Other side effects of these drugs are nausea, vomiting, diarrhea, hair loss, high blood pressure, and osteoporosis.
Steroids can also raise the risk of osteoporosis, as well as heart disease, heart attack, congestive heart failure, and stroke, says Ardoin. While belimumab is generally well tolerated, side effects can include infections, infusion reactions, headache, nausea, and fatigue.
Regular visits allow your rheumatologist to make sure the medications you’re taking are helping with the symptoms they should be helping with — and to make sure the drugs aren’t causing any side effects that could be problematic. And if there are problems or changes, your doctor can figure out how to adjust your treatment plan accordingly.
Lifestyle Changes That Can Help You Manage Lupus
In addition to prescribing medications, doctors may also recommend lifestyle changes to help manage lupus. These may include avoidance of sun exposure and paying more attention to managing stress to prevent lupus flares (periods of time when symptoms become problematic). 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.