Lupus (Systemic Lupus Erythematosus)
Treatment Overview
Your treatment choices for lupus (systemic lupus erythematosus, or SLE) depend on how severe your symptoms are, whether your organs are affected, and how much your symptoms are affecting your daily life. Your treatment plans should be tailored to your individual needs and will change over time, as the disease flares or ebbs. There currently is no cure for lupus.
You may be able to control your symptoms with self-care and medication. Self-care includes learning as much as possible about lupus, maintaining good communication with your health professional, and developing a healthy lifestyle. Medications that may be used to treat lupus include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antimalarials, and immunosuppressants.
Initial treatment
The goal of treatment for mild lupus is to prevent symptom flares—when fatigue, joint pain, and rash get worse. Maintain a schedule of regular checkups with your health professional, instead of waiting until your disease flares. When flares do occur, the goal is to treat them rapidly to limit any damage to body organs.
Treatment for mild lupus includes:
- Avoiding the sun. If you must be in the sun, cover your arms and legs, wear a hat, and apply broad-spectrum sunscreen (covering both UVA and UVB rays) with a high sun protection factor (such as SPF 50) to protect your skin.
- Applying corticosteroid cream for rashes.
- Taking nonsteroidal anti-inflammatory drugs (NSAIDs) and getting plenty of rest for mild joint or muscle pain and fever.
- Taking antimalarial medications to treat fatigue, joint pain, skin rashes, and lung inflammation.
- Taking low-dose corticosteroids if NSAIDs aren't effective in controlling your symptoms.
For more severe cases of lupus, treatment may include:
- Higher-dose corticosteroids, either in pills or by injection.
- Medications that suppress the immune system (immunosuppressants).
Good self-care is essential to managing lupus. A healthy lifestyle may reduce the frequency and severity of flares, resulting in an improved quality of life. Self-care includes:
- Regular exercise.
- Education about lupus and self-care.
- Not smoking.
- Eating a healthful, balanced diet.
- Developing a support system of family, friends, and health professionals.
Treatment for the skin rash that many people develop with lupus starts with sunscreens, sun avoidance, and clothing to protect skin from the sun. If needed, medications may include antimalarials, corticosteroid creams and pills, and retinoids such as acitretin. Some treatments work for some people but not for others, and some treatments may have long-term side effects. More research is needed to determine which of these treatments is safest and most effective.
Ongoing treatment
Progression of lupus varies by the individual. Flares and remissions can occur abruptly, unexpectedly, and without clear cause. The major goal for ongoing treatment of lupus is prevention or management of damage to the body organs, including the arteries, kidneys, bones, and brain.
To control mild but continuing symptoms of lupus, treatment includes:
- Avoiding the sun. If you must be in the sun, cover your arms and legs, wear a hat, and apply broad-spectrum sunscreen (covering both UVA and UVB rays) with a high sun protection factor (such as SPF 50) to protect your skin.
- Applying corticosteroid cream for rashes.
- Taking nonsteroidal anti-inflammatory drugs (NSAIDs) and getting plenty of rest for mild joint or muscle pain and fever.
- Taking antimalarial medications to treat fatigue, joint pain, skin rashes, and lung inflammation.
- Taking corticosteroids if NSAIDs aren't effective in controlling your symptoms.
If your lupus symptoms are more severe and damage to organs is threatened, treatment may include:
- Corticosteroids in higher dose, for serious complications needing longer-term treatment.
- Medication that suppresses your immune system (immunosuppressants).
Good self-care is essential to managing lupus. A healthy lifestyle may reduce the frequency and severity of flares, resulting in an improved quality of life. Self-care includes:
- Regular exercise.
- Education about lupus and self-care.
- Not smoking.
- Eating a healthful, balanced diet.
- Developing a support system of family, friends, and health professionals.
Treatment if the condition gets worse
If you have severe complications of lupus that seriously impact your quality of life or are life-threatening or causing serious organ damage, you will likely need aggressive treatment, which may include:
- High-dose corticosteroids.
- Medication that suppresses your immune system (immunosuppressants), necessary to prevent permanent damage to your organs and possible death.
Proper self-care is essential for the successful management of lupus. It improves your quality of life and may help delay flares (times when your symptoms get worse). For example, you may be able to limit symptom flares by protecting against sun exposure, avoiding and promptly treating infections, and keeping your stress level as low as you can. Stress reduction techniques include exercise and simplifying your schedule. Getting plenty of rest may offset the fatigue that is common in lupus.
Some people with lupus produce a protein (antibody) that attacks certain blood-clotting factors, which can cause the blood to clot easily. This condition, called antiphospholipid antibody syndrome, can lead to mild or severe blood-clotting complications. If you develop this condition, you may need anticoagulant medication to slow blood clotting. This is especially important if you have already developed blood clots. If you have antiphospholipid antibody syndrome but have not had any blood clots, you may be able to take aspirin. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that is sometimes used to slow blood clotting.
If you develop serious kidney disease that cannot be controlled with medication, you may need dialysis or a kidney transplant.
What To Think About
Corticosteroid treatment and physical inactivity put people with lupus at great risk of bone thinning (osteoporosis). Getting an adequate supply of calcium and vitamin D may slow the bone thinning process. Your health professional may also prescribe bisphosphonates, a type of medication that is also used for the prevention and treatment of osteoporosis. For more information, see the topic Osteoporosis.
Lupus treatment is complicated by several factors:
- The course and pattern of lupus symptoms vary widely.
- Flares and remissions can occur at any time, making it hard to tell how you are responding to treatment or which treatments are most helpful.
- Some treatment side effects can be as troubling as the symptoms of lupus.
It may not be possible to completely eliminate all of your symptoms for long periods of time, especially without the side effects from medications. Work closely with your health professional to reach a balance between reasonably controlling your symptoms, preventing damage to your organs, and minimizing side effects of long-term drug treatment. For example, you may take a dose of medication that will control lupus enough to prevent organ damage, but you may still have symptoms such as mild skin rash, muscle aches, and joint pain. Using higher doses of medications for a long time increases the risk of serious side effects. Your health professional will prescribe a dose that controls only the most serious, life-threatening symptoms and balances the risks of the medications with the benefits of controlling your symptoms.
The hormones in birth control pills (oral contraceptives) have not proven to be harmful in women with stable, moderate lupus.3 Women with lupus that is not well controlled may choose to use nonhormonal birth control methods, such as a condom or a diaphragm. For more information, see the topic Birth Control, and discuss your options with your health professional.
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| Author: | Shannon Erstad, MBA/MPH | Last Updated: May 13, 2008 |
| Medical Review: | Adam Husney, MD - Family Medicine Anne C. Poinier, MD - Internal Medicine Stanford M. Shoor, MD - Rheumatology | |
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