How Is Lupus Treated?
Lupus symptoms vary from one person to another. Once you have been diagnosed with lupus, the best treatment approach is with a health care team that will tailor treatment to your specific condition, based on your age, symptoms, general health, and lifestyle.
There are many categories of drugs physicians use to treat lupus. However, the U.S. Food and Drug Administration or “FDA” has approved only a few specifically for lupus, which include:
Corticosteroids, including prednisone, prednisolone, methylprednisolone, and hydrocortisone
Antimalarials, such as hydroxychloroquine (Plaquenil®) and chloroquine
The monoclonal antibody belimumab (Benlysta®)
Drugs play an important role in treating lupus. Most likely, the drugs prescribed to you will change often during your treatment. Types of drugs commonly used to treat lupus include:
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are used to reduce pain and swelling in joints and muscles. They can help with mild lupus when pain isn't too bad and vital organs are not affected. Aspirin, ibuprofen, and naproxen are some over-the-counter NSAIDs. You need a prescription for stronger ones. NSAIDs can cause stomach upset, heartburn, drowsiness, headache, fluid retention, and other side effects. If overused, NSAIDs also can cause problems in your gastrointestinal tract (which includes the stomach), blood, liver, and kidneys. In pregnant women, NSAIDs should be avoided after the first trimester. They should be used with caution in women who breastfeed.
Corticosteroids. Corticosteroids (KOR-tih-koh-STEER-oyds) are hormones found in our bodies. Manmade versions, often called "steroids," are used to reduce swelling, tenderness, and pain in many parts of the body. In high doses, they can calm the immune system. These drugs are different than steroids used by some people who play sports or lift weights. Corticosteroids come as pills or liquids, creams to apply to the skin, and as shots. Prednisone is one that is commonly used to treat lupus. Lupus symptoms tend to respond very quickly to these powerful drugs. Once this has happened, your doctor will want to lower your dose slowly until you no longer need it. The longer a person uses these drugs, the harder it becomes to lower the dose. But stopping this medicine right away can harm your body. Make sure to use your medicine exactly as your doctor tells you to.
Corticosteriods can have many side effects, so your doctor will give you the lowest dose possible. Short-term side effects can include: a round or puffy face, acne, heartburn, increased appetite, weight gain, and mood swings. These side effects typically stop when the drug is stopped. However, the weight gain will not reverse on its own, so be careful not to overeat while on steroids. Long-term side effects can include: easy bruising, thinning skin and hair, weakened or damaged bones, high blood pressure, damage to the arteries, high blood sugar, infections, muscle weakness, and cataracts. Some people may have ulcers, depression, or even congestive heart failure. Your doctor can prescribe medicines to take with corticosteroids to prevent some side effects. Corticosteroids can be used during pregnancy with your doctor's supervision
Antimalarial drugs. Medicines used to prevent or treat malaria are used to treat joint pain, skin rashes, fatigue, and inflammation of the lungs. Two common antimalarials are hydroxychloroquine sulfate (Plaquenil®) and chloroquine phosphate (Aralen® phosphate). Side effects of antimalarials can include stomach upset, nausea, vomiting, diarrhea, headache, dizziness, blurred vision, trouble sleeping, and itching. People treated with antimalarials should see an eye doctor every year, because of the low risk of eye problems. Studies have found that taking antimalarials can stop flares and some help people with lupus live longer.
BLyS-specific inhibitors. The first medication approved by the Food and Drug Administration under this new class of drugs is called belimumab (Benlysta®). It limits the amount of autoantibodies found in people with lupus. The drug blocks the action of a specific protein in the body that is important in immune response. Two clinical studies in more than 1,600 people with lupus showed Benlysta to be safe and effective. However, the research did not have enough data showing Benlysta to be effective in African-Americans, so another study is being done. In clinical studies, people taking Benlysta reported more deaths and serious infections than those not taking the drug. Benlysta should not be given with live vaccines. The most common side effects included nausea, diarrhea, and fever.
Immunosuppressive agents/chemotherapy. These agents are used in severe cases of lupus, when major organs are affected by lupus and other treatments do not work. These drugs suppress the immune system to limit the damage to the organ. Examples are azathioprine (Imuran®), and cyclophosphamide (Cytoxan®), mycophenolate mofetil (Cellcept), and methotrexate (Rheumatrex® and Trexall®). These drugs can cause serious side effects including nausea, vomiting, hair loss, bladder problems, decreased fertility, and a risk of cancer and infection. These drugs can also cause birth defects. If you take these medicines, your doctor may tell you to avoid pregnancy.
You and your doctor should review your treatment plan often to be sure it is working. Also, you may need other drugs to treat conditions that are linked to your lupus — such as high blood pressure, osteoporosis, or blood clots. Many people with lupus are prescribed anticoagulants ("blood thinners"), such as warfarin (Coumadin®) or heparin, because of the risk of blood clots. An untreated blood clot can cause a stroke or heart attack. Pregnant women should not take warfarin.
Tell your doctor about any side effects or if your medicines no longer help your symptoms. Tell your doctor if you have new symptoms. Never stop or change treatments without talking to your doctor first.
Are there options for treating my lupus with complementary or alternative medicine?
Some people with lupus try creams, ointments, fish oil, supplements, special diets, or homeopathy, or see a chiropractor, to care for their lupus. Some people with lupus have said these help. However, research has not proven that any of these alternatives successfully treats lupus or reduces the risk of other problems. More importantly, research has not been done to show whether these therapies could be harmful. That is why you must talk to your doctor before trying any alternative remedy. Don't stop or change your prescribed treatment without first talking to your doctor.
Is Lupus A Terminal Disease?
Lupus is not considered a terminal disease. It is a chronic disease that can lead to an early death if not properly maintained. Many men and women live long, productive lives with lupus. However, it can be fatal for some people. It depends on the severity of illness, how the body responds to treatments, and other factors. Infections in the Kidneys, heart and lungs along with brain issues are the leading cause of death in people with lupus.
Lupus tends to have a dormant, inactive stage during which the patient lives a normal, or nearly normal lifestyle. There is also an active stage, called a flare, during which the symptoms are severe, and can range from irritating to crippling. Studies show that people with lupus are living longer lives compared to decades past.