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Lupus Treatment

How is lupus treated?

There is no cure for lupus, but for most people treatment can reduce symptoms and protect against serious organ damage. Medications are an important part of managing lupus. Your physician will determine the best medication combination for you.

Patients with lupus have normal fertility and can have children. If you are considering pregnancy or trying to get pregnant, your rheumatologist may suggest delaying pregnancy until your disease has been under control for at least six months. Delaying pregnancy can help to reduce the risk of lupus-related pregnancy complications. Frequent monitoring and visits with a rheumatologist are important.

Treatment for Mild Lupus

Mild lupus generally involves arthritis and skin rashes. Treatments for mild lupus include:

  • Antimalarial drugs (HCQ)
  • Topical corticosteroids
  • Anti-inflammatory drugs (Aleve, Naproxen, Advil, Motrin, Ibuprofen)
  • Low-dose corticosteroids prednisone < 10 mg (always try to avoid)
  • Health maintenance, preventative measures
  • Rest
  • Avoid sun exposure

Treatment for Moderate Lupus

Treatments for moderate lupus when it involves arthritis with moderate loss of function include:

  • Antimalarial drugs (HCQ): 200-400 mg
  • Anti-inflammatory drugs (Aleve, Naproxen, Advil, Motrin, Ibuprofen)
  • Prednisone > 10 mg
  • Methotrexate
  • Azathioprine

Treatments for moderate lupus when it involves a more severe skin rash and alopecia include:

  • Antimalarial drugs (HCQ): increase to 600 mg
  • Add Quinicrine 50 mg M-F
  • Consider switching to chloroquine
  • Prednisone > 10 mg
  • Methotrexate
  • Azathioprine

Treatment for Severe Lupus

Severe lupus is characterized by symptoms which may include a severe rash, kidney disease, brain disease, bleeding into lungs, and low blood counts. Treatment often involves potent immunosuppressive drugs and requires close monitoring for disease flares and/or medication side effects. Patients with severe lupus may consider participation in clinical trials. Treatments for severe lupus include:

  • Antimalarial drugs (HCQ): 400 mg
  • Prednisone high dose = 1 mg/kg
  • Cyclophosphamide intravenous
  • Mycophenolate Mofetil, brand Cellcept ®
    • Generally well-tolerated
    • Turns down immune system
    • FDA-approved for use in people receiving organ transplants
    • Many have fewer side effects than older medications
    • Equal to cyclophosphamide for induction of SLE nephritis
    • Superior to Imuran for maintenance of SLE nephritis
Biological Therapies

Treatments for severe lupus may include biological therapies. These therapies involve proteins that affect cells or signals in the immune system. Many were developed first for other conditions. Usually, they need to be injected or infused (IV).

  • Belimumab [LymphoStat-B ®] (Benlysta): Allows autoantibody-producing B cells to die. Belimumab proved successful in two pivotal clinical trials in 2009. People with lupus who were treated with Belimumab had improvement in disease activity without clinically significant flare-ups when compared to patients who received the placebo. The patients receiving Belimumab also were able to reduce their intake of steroids. The study is the largest ever to be completed for lupus and the first Phase III trial of a new biologic immune therapy for lupus to succeed in meeting its primary endpoint and most of its secondary endpoints. Belimumab had received a Fast Track Product designation from the U.S. Food and Drug Administration.
  • Abatacept (Orencia ®): Approved for the treatment of rheumatoid arthritis to treat joint pain and inflammation.
  • Infliximab (Remicade ®): Infliximab blocks TNF and is approved for use in rheumatoid arthritis and inflammatory bowel disease. It may provoke SLE; however, some studies show benefit especially in kidney disease with SLE.
  • Rituximab (Rituxan ®, Mabthera ®): Rituximab kills B cells and turns down production of autoantibodies. It is FDA-approved for use in lymphoma and rheumatoid arthritis and may have fewer infectious side effects compared to other medications. Phase III clinical trials in lupus nephritis and active lupus without nephritis did not show efficiency but open-label studies in some types of SLE patients show benefit.

Lifestyle Changes

  • Sleep: Proper amounts of rest are extremely important for people with lupus. Rest helps with fatigue and when experiencing flares. At least 7 hours of sleep per night is a good goal and napping is helpful and sometimes necessary. Allow extra time in your day to rest.
  • Exercise: Regular exercise and even simple, low-impact movement will reduce or minimize stress, help keep your heart healthy, improve muscle strength and reduce muscle stiffness, increase your range of motion, and help prevent osteoporosis. Like everyone, people with lupus should exercise regularly. Perform low impact activities if you are experiencing swollen joints or muscle pain (walking, bicycling, yoga/pilates, stretching). Exercise plans should be discussed with your physician.
  • Diet: There is no special diet for people with lupus. A nutritious, well-balanced diet is advised, which includes fruits, vegetables, whole grains, and moderate amounts of poultry and fish. Avoid alfalfa sprouts, which may trigger flares. Due to increased risk of osteoporosis, it may be helpful to eat foods rich in calcium, such as green leafy vegetables, milk, cheese, and yogurt. Alcohol can be used in moderation, but may complicate the use of some medications, such as NSAIDS, anticoagulants, and methotrexate. Herbs, supplements, and vitamins should be discussed with your physician. Salt should be eliminated if fluid retention is a problem, and fat and salt should be eliminated if you are on corticosteroids.
  • Smoking: Tobacco is especially harmful to people with lupus. Smoking impairs the body's entire circulatory system and increases the risk of atherosclerosis, a condition often seen in lupus patients. Flares in cutaneous lupus have also been linked to an ingredient in tobacco.
  • Sun Sensitivity: Excessive exposure to the sun can cause a lupus flare. Two-thirds of people with lupus have increased sensitivity to UV rays: sunlight, artificial light, or both. Avoid sunlight between the hours of 10 AM and 4 PM and use sunscreen with both UVA and UVB protection when outdoors. Clothing and hats also help protect from UV light. For indoor light exposure, there are shields that cover fluorescent bulbs which can be ordered.
  • Coping Strategies: Learning to cope with lupus can involve finding strategies to cope with fatigue, stress, depression, anger, guilt, and intimacy. Identifying stressors and finding methods to control stress, informing your doctor when depression is prolonged, and communicating with family and friends are all important aspects of managing lupus.
  • Workplace changes: Your employer may offer short-term or long-term disability benefits. Learn more about disabilities in the workplace through the American Disabilities Act.