Treatments for Lupus
Because the symptoms of lupus vary from one person to another, the treatment of the disease is tailored to the specific problems that arise in each person. In many cases, the best approach to treating your lupus is with a health care team.
Today, doctors are using a wide variety of medicines to treat lupus -- ranging in strength from mild to extremely strong. It is not unusual for the prescribed medications to change during a person’s lifetime with lupus. However, it can take months, and sometimes years, before your health care team finds just the right combination of medicines to keep your lupus symptoms under control.
There are many categories of drugs for the treatment of lupus. Of all these drugs, only a few are approved specifically for lupus by the Food and Drug Administration (FDA): corticosteroids, including prednisone, prednisolone, methylprednisolone, and hydrocortisone; the antimalarial, hydroxychloroquine (Plaquenil®); monoclonal antibodies (Benlysta®); and aspirin. However, many medications are used to treat the symptoms of lupus.
People with lupus are generally treated by a rheumatologist, a doctor who specializes in diseases of the joints and muscles. If lupus has caused damage to a particular organ, other specialists will be consulted as well, such as a dermatologist for cutaneous lupus (skin disease), a cardiologist for heart disease, a nephrologist for kidney disease, a neurologist for brain and nervous system disease, or a gastroenterologist for gastrointestinal tract disease. An obstetrician who specializes in high-risk pregnancies will be needed when a woman with lupus is considering a pregnancy.
Once you have been diagnosed with lupus, your doctor will develop a treatment plan based on your age, symptoms, general health, and lifestyle. The goals of any treatment plan are to:
- reduce inflammation caused by lupus
- suppress your overactive immune system
- prevent flares, and treat them when they occur
- control symptoms like joint pain and fatigue
- minimize damage to organs
People with lupus often require other drugs for the treatment of conditions commonly seen with the disease. Examples of these types of medications are diuretics for fluid retention, antihypertensive drugs for high blood pressure, anticonvulsants for seizure disorders, antibiotics for infections, and bone-strengthening drugs for osteoporosis.
In addition, many medications, whether listed in this on the lupus.org website or not, are not recommended for a woman who is planning a pregnancy, is currently pregnant, or is breast-feeding. Women with lupus should have every pregnancy closely monitored by their health care team, so that the safest decisions can be made about medication use and any other necessary treatments, both before, during, and after the birth.
All medicines must be taken exactly as prescribed! Forgetting to take the medicine, taking medicine in the wrong amounts or dosage, stopping a medicine, or adding dietary supplements without your doctor’s approval will affect how well the drugs work and whether your symptoms of lupus can be brought under control.
Managing lupus is a team effort. And since there often will be several physicians involved in your care, good communication is necessary among members of your health care team.
Frequently Asked Questions
How is lupus treated?
There are many categories of drugs for the treatment of lupus. Of all these drugs, only a few are approved specifically for lupus by the Food and Drug Administration (FDA): corticosteroids, including prednisone, prednisolone, methylprednisolone, and hydrocortisone; the antimalarial, hydroxychloroquine (Plaquenil®); monoclonal antibodies (Benlysta®); and aspirin. However, many medications are used to treat the symptoms of lupus.
What happens if one decides not to treat lupus?
Because lupus is such a heterogeneous disease, it is difficult to predict or generalize about what would happen if it were left untreated. For the individual patient, a critical question would be what disease manifestations they have. This is because the management and treatment of lupus should be guided by the degree and severity of clinical manifestations. Thus, up to 50% of lupus patients may have non-life threatening features, such as fatigue, joint pain, and rash. Non-steroidal anti-inflammatories (e.g. ibuprofen) and anti-malarials (plaquenil) are frequently used for symptomatic relief in this case. Because there is a risk of disease flare with more severe organ involvement (kidney or lung/heart inflammation, for example), lupus patients should have regular evaluations to make sure life-threatening involvement is not developing. Many lupus doctors prescribe antimalarials even in the setting of mild disease because there is good evidence they may decrease the frequency and severity of flares and have low toxicity.
For patients with severe organ involvement (like kidney inflammation) treatment is very important. Before medications (like steroids and other immunosuppressives) were available to treat lupus, overall 5 year survival rates were less than 50%. With expanded therapeutic options, 5 year survival rates are now over 95%.
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