Treatment for Systemic Lupus Erythematosus (SLE)
There is no cure for lupus, and the goals of treatment are to
- minimize symptoms,
- to reduce inflammation in the body,
- to prevent damage to organs of the body, and
- to maintain function.
Because the course of the disease varies from patient to patient, there are a number of different treatment plans. In many cases, preventative treatment can reduce the frequency and severity of flares (periods of worsening symptoms).
It is important for patients with lupus to avoid excessive sun exposure and wear sunscreen daily. In fact, it is the ultraviolet rays of the sun that causes lupus to become more active. Although the sun is the major source of UV rays, UV light also is produced by many other sources, including lights commonly found in homes and work. In fact, the newer "green" fluorescent light bulbs emit higher amounts of UV light than the older incandescent bulbs. Therefore, it is recommended that patients who have SLE wear sunscreen every day, even if they don't go outside, and even in the winter season. On sunny days, patients should apply sunscreen 23 times a day.
Other factors that can potentially worsen lupus and should be avoided include eating bean sprouts and taking Echinacea (herb that stimulates the immune system).
It also is recommended that patients:
- Avoid smoking (patients with SLE have an increased risk for heart attack at a younger age that people who do not have the condition, and smoking prevents Plaquenil®, the most commonly prescribed treatment, from working)
- Have regular medical checkups
- Take medication as prescribed
- Exercise regularly
- Take a vitamin D supplement regularly if blood levels are low
In some cases, women with lupus are unable to tolerate oral contraceptives (birth control pills) or estrogen replacement therapy (ERT). Patients should check with their rheumatologist to see if it is safe to take hormones or not. Sulfonamide, which is present in some antibiotics, also has been shown to cause flares in patients with SLE. Patients who have lupus should always list sulfa antibiotics, such as Septra® and Bactrim®, as medicines to which they are allergic.
Medications to Treat Lupus
The types of medications used to treat lupus depend on which organs are affected and on the severity of symptoms. Medications that are commonly used include the following:
- Non-steroidal anti-inflammatory drugs (NSAIDs; e.g., aspirin, ibuprofen [Advil®, Motrin®], naproxen [Naprosyn®], indomethacin [Indocin®])
- Acetaminophen (e.g., Tylenol)
- Corticosteroids (e.g., Prednisone)
- Antimalarials (e.g., chloroquine [Aralen], hydroxychloroquine [Plaquenil])
- Immunosuppressant drugs (e.g., methotrexate, CellCept [mycophenolate], azathioprine [Imuran], cyclophosphamide)
- Biologic medications (belimumab [Benlysta], and rituximab [Rituxan])
NSAIDs are used to treat muscle and joint pain and inflammation. These drugs may cause gastrointestinal side effects (e.g., stomach pain, gastrointestinal bleeding) and should be taken with meals. Antacids and other medications, such as Cytotec and Prilosec may further reduce the risk for these side effects. Some NSAIDs, such as Arthrotec and Celebrex, are less likely to cause ulcers. Kidney function and blood pressure must be monitored regularly while taking these medications.
Corticosteroids, which are hormones that reduce inflammation and suppress the immune system, cause a number of side effects (e.g., weight gain, high blood pressure, risk for infection, osteoporosis, cataracts, diabetes). It is important to regulate the dose of these medicines to maximize the benefit and reduce the risk for adverse effects. The risks are higher when the medication is taken for a long period of time or at high doses.
Antimalarials may be prescribed for skin and joint symptoms of lupus. These medications rarely cause major side effects, but they may rarely affect the eyes. Patients who are taking antimalarials should have their eyes examined regularly (usually once a year). Plaquenil® is the most commonly prescribed antimalarial medications, and fortunately, it is rare to develop eye problems from it.
Immunosuppressive medications are sometimes needed to reduce inflammation and suppress the immune system. Side effects include anemia (low red blood cell count), low white blood cell count, and an increased risk for infection. Patients using some of these drugs may also develop a predisposition to cancer in the future.
Biologic medications, are produced using complex biologic procedures and target specific parts of the immune system. They must be given either intravenously or by an injection under the skin (subcutaneously). In March 2011, the U.S. Food and Drug Administration (FDA) approved belimumab (Benlysta) to be used with standard lupus treatment. This drug, which is a monoclonal antibody, is the first new treatment for lupus in over 50 years. Belimumab is administered through an IV (intravenously) to help reduce levels of abnormal B cells in patients with lupus and lessen the severity of symptoms. Side effects include diarrhea, nausea, and fever.
Other Lupus Treatments
If the kidneys are involved, a biopsy (surgical removal of a small piece of tissue for microscopic evaluation) is performed to determine what type of disease process is occurring. This information is necessary to develop the correct treatment plan.
If renal failure occurs, hemodialysis is the preferred treatment over peritoneal dialysis. Patients who experience kidney failure can be considered for renal transplant because the risk for development of the disease in the transplanted kidney is low.
Severe cases of inflammation in and around the lungs and heart may require surgical drainage, especially if fluid surrounding the heart decreases its ability to pump blood (called cardiac tamponade).
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