Lupus treatment plans are tailored to the individual's needs and may change over time. The range and effectiveness of treatments for lupus have increased, giving doctors more choices in how to manage the disease. It is important for the patient to work closely with the doctor and take an active role in managing the disease. Once lupus has been diagnosed, the doctor will develop a treatment plan based on the patient's age, sex, health, symptoms, and lifestyle. In developing a treatment plan, the doctor has several goals:
- to prevent flares
- to treat flares when they do occur
- to minimize organ damage and complications
The doctor and patient should reevaluate the plan regularly to ensure it is as effective as possible.
NSAIDs: For people with joint or chest pain or fever, drugs that decrease inflammation, called NSAIDs, are used. While some NSAIDs, such as ibuprofen and naproxen, are available over-the-counter, a doctor's prescription is needed for others. NSAIDs may be used alone or in combination with other types of drugs to control pain, swelling, and fever. Even though some NSAIDs may be purchased without a prescription, it is important that they be taken under a doctor's direction. Common side effects of NSAIDs can include:
- stomach upset
- fluid retention
Some people also develop liver, kidney, cardiovascular, or even neurological complications, making it especially important to stay in close contact with the doctor while taking these medications.
Antimalarials: Antimalarials are another type of drug commonly used to treat lupus. These drugs were originally used to treat malaria, but doctors have found that they also are useful for lupus. A common antimalarial used to treat lupus is hydroxychloroquine (Plaquenil). It may be used alone or in combination with other drugs and generally is used to treat:
- joint pain
- skin rashes
- lung inflammation
Studies have found that continuous treatment with antimalarials may prevent flares from recurring. Side effects of anti-malarials can include:
- stomach upset
- damage to the retina of the eye (rare)
Corticosteroids: The mainstay of lupus treatment involves the use of corticosteroids, such as:
- prednisone (Deltasone)
- methylprednisolone (Medrol)
- dexamethasone (Decadron, Hexadrol)
Corticosteroids are related to cortisol, a natural anti-inflammatory hormone. They work by rapidly suppressing inflammation. Corticosteroids can be given:
- by mouth
- in creams applied to the skin
- by injection
Because they are potent drugs, the doctor will seek the lowest dose with the greatest benefit. Doctors sometimes give very large amounts of corticosteroid by vein over a brief period of time (days) ("bolus" or "pulse" therapy). Short-term side effects of corticosteroids include:
- increased appetite
- weight gain
These side effects generally stop when the drug is stopped. It is dangerous (even life threatening) to stop taking corticosteroids suddenly, so it is very important that the doctor and patient work together in changing the dose.
Long-term side effects of corticosteroids can include:
- stretch marks
- weakened or damaged bones (osteoporosis and osteonecrosis)
- high blood pressure
- damage to the arteries
- high blood sugar (diabetes)
Typically, the higher the dose and the longer they are taken, the greater the risk and severity of side effects. People with lupus who are using corticosteroids should talk to their doctors about taking supplemental calcium and vitamin D or medications to reduce the risk of osteoporosis.
Immunosuppressives: For some patients whose kidneys or central nervous systems are affected by lupus, a type of drug called an immunosuppressive may be used. Immunosuppressives, such as cyclophosphamide (Cytoxan) and mycophenolate mofetil (CellCept), restrain the overactive immune system by blocking the production of immune cells. These drugs may be given by mouth or by infusion (dripping the drug into the vein through a small tube). Side effects may include:
- hair loss
- bladder problems
- decreased fertility
- increased risk of cancer and infection
The risk for side effects increases with the length of treatment. As with other treatments for lupus, there is a risk of relapse after the immunosuppressives have been stopped.
DMARDs: In some patients, methotrexate, a disease-modifying antirheumatic drug, may be used to help control the disease.
Benlysta for Lupus
Benlysta (belimumab) was approved on March 9, 2011 by the FDA for the treatment of active, autoantibody-positive lupus in patients who are receiving standard therapy including corticosteroids, antimalarials, immunosuppressives, and NSAIDs (nonsteroidal anti-inflammatory drugs). Benlysta is administered as an intravenous infusion. It is the first drug to target B-lymphocyte stimulator (BLyS) protein which should decrease the number of abnormal B cells -- thought to be a problem in lupus.
Working closely with the doctor helps ensure that treatments for lupus are as successful as possible. Because some treatments may cause harmful side effects, it is important to report any new symptoms to the doctor promptly. It is also important not to stop or change treatments without talking to the doctor first.