Medications are an important aspect of the management of many patients with systemic lupus erythematosus. An array of drug options are now available, which have increased the potential for effective treatment and excellent patient outcomes.
The goals for treating a patient with lupus include:
- reducing inflammation caused by the disease
- suppressing immune system abnormalities that are responsible for tissue inflammation
- preventing flares and treating them when they do occur
- minimizing complications
Lupus patients should work with their doctors to develop their own treatment plan. Once a person has been diagnosed with lupus, a drug treatment plan will be developed by their doctor based on a person’s:
It is important that patients thoroughly understand:
- the reason for taking a drug
- its action
- administration times
- side effects
Pharmacists also can be a good resource for patients in helping them understand their medication treatment plan. If a patient experiences a problem believed to be related to a drug, the patient should notify her or his doctor immediately. It can be dangerous to suddenly stop taking some medications, and patients should not stop or change treatments without first talking to their doctor.
The array of medications and the complexity of treatment plans can be overwhelming and confusing. Most patients do well on lupus medications and experience few side effects. Those who do experience side effects or adverse events should not become discouraged, since alternative drugs are often available.
Lupus treatment should include as few medications for as short a time as possible. Some patients never require medications, and others take them only as needed or for short intervals, but many require constant therapy with variable doses. Despite their usefulness, no drugs are without risks. Medications frequently used to control lupus symptoms are:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- immunosuppressives/disease-modifying anti-rheumatic drugs (DMARDs)
Other medications may be necessary to control specific manifestations or to treat other conditions commonly seen with the disease. These include:
Medications used to treat lupus should be reevaluated regularly and revised as necessary to ensure treatment is as effective as possible.
Nonsteroidal anti-inflammatory drugs (NSAIDs) comprise a large and chemically diverse group of drugs that possess analgesic, anti-inflammatory, and antipyretic properties. Pain and inflammation are common problems in patients with lupus, and NSAIDs are usually the drugs of choice for patients with mild lupus with little or no organ involvement. Patients with serious organ involvement may require more potent anti-inflammatory and immunosuppressive drugs.
There are many NSAIDs on the market, and new ones are constantly becoming available. Some NSAIDs can be purchased as over-the-counter drugs, whereas larger doses are available only by prescription.
The therapeutic effects of NSAIDs stem from their ability to inhibit the release of prostaglandins and leukotrienes, which are responsible for producing inflammation and pain. NSAIDs are very useful in treating:
An NSAID may be the only drug needed to treat a mild flare; more active disease may require additional medications.
Although all NSAIDs appear to work in the same way, not every one has the same effect on every person. In addition, patients may do well on one NSAID for a period of time, then, for some unknown reason, derive no benefit from it. Switching to a different NSAID may produce the desired effects. Patients should use only one NSAID at any given time.
Antimalarials were first developed during World War II because quinine, the standard treatment for malaria, was in short supply. Investigators found antimalarials could also be used to treat the joint pain that occurs with rheumatoid arthritis. Subsequent use has shown that these drugs are effective in controlling:
- lupus arthritis
- skin rashes
- mouth ulcers
Antimalarials are not used to manage more serious, systemic forms of lupus that affect the organs. It may be weeks or months before the patient notices that these drugs are controlling disease symptoms.
- Hydroxychloroquine sulfate (Plaquenil)
- Chloroquine (Aralen)
Although chloroquine is still used, due to better safety, hydroxychloroquine is usually preferred. The anti-inflammatory action of these drugs is not well understood. In some patients who take antimalarials, the total daily dose of corticosteroids can be reduced. Antimalarials also affect platelets to reduce the risk of blood clots and lower plasma lipid levels.