A Closer Look at Lupus Treatments

Medications to treat symptoms and suppress your immune system, along with some alternative therapies.

Since lupus presents differently in each person, treatment will be personalized for your specific needs. As your needs change, according to different stages in your life and in your lupus experience, your treatments may need to be modified. This typically will depend on the severity of symptoms, as well as on the systems and organs the lupus is affecting. In mild lupus cases, symptoms can often be managed with one or two uncomplicated medications. However, if you have moderate or severe lupus, your doctor will prescribe more aggressive treatments. And even with mild lupus, if you experience a flare-up of symptoms, you will also benefit from more aggressive treatments for a few weeks. Getting enough sleep and exercising will reduce your fatigue, and that may also alleviate some of your joint pain.

Doctors frequently discontinue a medication after the disease enters a period of remission. So, it is important to see your doctor frequently, allowing him or her to adjust your treatments according to your symptoms.

Lupus TreatmentsLupus treatment includes NSAIDs, steroids, and other drugs that suppress the immune system. (Source: 123RF)

Medications

Hydroxychloroquine is an antimalarial drug that is commonly used to treat lupus. It reduces joint pain and helps prevent lupus flare-ups. It also reduces inflammation in the linings that protect your heart and lungs, and it relieves lupus-related fatigue and fever. Some people experience an upset stomach from this medication and in rare cases, it can damage the retina of the eye, so it’s important to get regular eye exams while taking this medication.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, celecoxib, diflunisal, and naproxen are very effective at treating pain, fevers, and inflammation from lupus. However, because of their side effects, some doctors encourage their patients to use NSAIDs mainly for lupus flares. Using NSAIDs over a long period of time can damage your digestive system and kidneys.

NSAIDs can also cause headaches, skin rashes, and other symptoms that mimic lupus flares. This makes it harder for your doctor to know if you need more aggressive lupus treatment—or if you are just experiencing NSAID side effects. If you have a flare-up, and hydroxychloroquine and NSAIDs are not providing enough relief, your doctor may choose to treat you with a corticosteroid (often referred to as a steroid), which is an anti-inflammatory treatment to help fight the infection.

Prednisone pills are the most common administration of a steroid. However, steroid injections and IVs can also be extremely effective. When taking a steroid, you could experience weight gain, bruising, osteoporosis, diabetes, high blood pressure, and be more likely to get an infection.

Suppressing Your Immune System 

When lupus threatens organs, doctors move aggressively to suppress your malfunctioning immune system with a class of medications that includes azathioprine, mycophenolate mofetil, and methotrexate.

While such drugs may dramatically reduce your lupus symptoms, they also carry some risks you’ll need to consider, including the possibility of liver damage, lowered fertility, and increased risk of cancer. Suppressing your immune system with these medications also increases your risk of infection. Therefore, you will need to safeguard your personal hygiene and avoid sick people.

These medications also interact with many other pharmaceuticals. If you live with other health conditions, you may have tough decisions to make about the tradeoff between treating lupus and the effect that the immune suppressors may have on your other conditions. Your doctor will help you make that decision.

There are also a few newer forms of treatments being tried for lupus with some success.  For instance, belimumab (brand name: Benlysta) is the first biologic (a medication made from live organisms) approved for lupus. It can be self-injected by patients, which offers important convenience. Some people experience mild side effects from this drug, including nausea, diarrhea and an increased risk of infections.

A recent study also explored the benefits of using rituximab (brand name: Rituxan) for people with resistant lupus. This can reduce reliance on steroids, and minimize related side effects. However, rituximab can increase the risk of infections in users.

Looking to the Future

“We are still awaiting a ‘home-run’ immune therapy for lupus, similar to the many breakthrough therapies for rheumatoid arthritis. Until then, the best option is early diagnosis and case-by-case treatment by a rheumatologist,” says Don Goldenberg, MD, rheumatologist and emeritus professor of medicine at the Tufts University School of Medicine in Boston, MA. He currently serves as adjunct faculty in the Department of Medicine and Nursing at Oregon Health & Science University in Portland, OR. He adds that the vast majority of lupus patients will have good outcomes, although ongoing treatment may be needed over the long-term.

Lifestyle Choices and Alternative Treatments

Making smart lifestyle choices—including eating a balanced diet, getting enough sleep, and engaging in regular exercise—can help you manage lupus. Some people with lupus also find complementary and alternative treatments to be helpful in controlling symptoms. Just be sure to talk to your doctor before trying anything new. There is always the risk that it can interfere with your medications.

Watching for Flare-ups 

You can prevent, or reduce the intensity of, a lupus emergency by learning to sense the onset of a lupus flare. If you sense a flare-up, you’ll need to start preventative treatment with your doctor. Some common warning signs are:

  • exhaustion;
  • rash;
  • pain;
  • fevers;
  • stomach aches;
  • headaches;
  • dizziness;
  • and aching muscles.

Working with a Rheumatologist

Lupus treatment is complex, and you need to have a doctor who is experienced in managing the symptoms. Early in the course of your illness, your primary care provider may be qualified to treat mild lupus. However, if you develop moderate or severe lupus symptoms, you will benefit from the additional experience and focus of a rheumatologist who specializes in the condition.

-Additional reporting by Lisa Ellis, October 2018

Updated on: 10/19/18
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