Lupus medications & treatments

Lupus is an autoimmune disease that causes widespread inflammation that can affect any part of the body. The Lupus Foundation of America estimates that about 1.5 million Americans, and at least five million people worldwide, have a form of lupus. They also estimate that there are 16,000 new cases of lupus per year. While it can affect anyone, ninety percent (90%) of people diagnosed with lupus are women. It is more common in African Americans, Hispanics, and Asian Americans than it is in Caucasians.

What is Lupus?

Lupus is a chronic autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation in many parts of the body. The most common areas affected are your joints, skin, kidneys, brain, heart, lungs, and blood vessels. For those with lupus, you may have flare-ups where you have symptoms and periods where you are symptom-free (remission).

Lupus is typically categorized into the following different types:

• Systemic lupus erythematosus (SLE). When you hear people talk about lupus, this is what they are usually referring to. It accounts for around 70% of all cases of lupus and can be mild to severe. This type of lupus affects many different organ systems of your body including your skin, joints, heart, lung, kidneys, circulating blood cells, and brain.
• Cutaneous lupus. This type of lupus causes skin rashes or lesions. About 10% of all lupus cases are cutaneous lupus. Cutaneous lupus commonly causes a rash over the cheeks and across the bridge of the nose, known as the “butterfly rash.”
• Drug-induced lupus. Drug-induced lupus erythematosus is usually a reversible condition that accounts for about 10% of all lupus cases. The symptoms typically resemble those of SLE but rarely affect your major organs. Your symptoms usually resolve within 6 months of you stopping the medication that caused them.
• Neonatal lupus. This rare condition affects infants who receive autoantibodies from their mothers with lupus. At birth, the baby can have a skin rash, liver issues, or low blood cell counts. Their symptoms typically disappear after six months and have no lasting effects.

Lupus causes

While experts do not know the cause of lupus, evidence suggests a combination of the following can put you at an increased risk of developing lupus:

• Genetics. Research shows that more than 50 genes associated with lupus have been identified and also having a family history can increase your risk of developing this condition.
• Environment. Certain triggers in the environment are thought to cause lupus including smoking, stress, medications, and viral infections.
• Hormones. Because lupus is more common in women than men, hormones (estrogen) could play a role in the development of lupus.
• Ethnicity. In the U.S., lupus is more common in African-Americans, Hispanics, Asian Americans, Native Americans, and Pacific Islanders, than in Caucasian people.
• Age. Lupus is most often diagnosed in people between the ages of 15 and 44.

How is Lupus diagnosed?

To properly diagnose lupus, your rheumatologist or healthcare professional may look at your signs and symptoms, review your medical history, perform a physical exam, and run some urine and blood tests.

Lupus symptoms

Lupus can affect any part of your body. Common symptoms of lupus include:

• Joint pain
• Joint stiffness and swelling
• Severe fatigue
• Fever
• Butterfly-shaped rash (around half of all lupus patients will develop this)
• Skin rash or lesions that worsen with sun exposure (photosensitivity)
• Chest pain when breathing deeply (pleurisy)
• Hair loss
• Mouth or nose ulcers
• Sjögren’s syndrome, which causes dry eyes and dry mouth
• Raynaud’s phenomenon, which causes your fingers and toes to turn white or blue when you are cold or stressed
• Headache
• Shortness of breath
• Confusion and memory loss

Along with your history of symptoms, your doctor may include some of the following tests and procedures to confirm a diagnosis of lupus:

• Complete blood count. This test checks for low levels of platelets, red blood cells, and white blood cells, which can indicate that you have lupus.
• Antinuclear antibody (ANA) test. This antibody is found in almost everyone with active lupus. If you have a positive ANA test, your doctor may order more-specific antibody testing
• Erythrocyte sedimentation rate (ESR). This test measures how quickly red blood cells may settle to the bottom of a test tube, with a high rate of settlement indicating high inflammation. An ESR test doesn’t diagnose one specific condition but can help your doctor determine what further testing may be needed.
• Metabolic panel. This test is used to look for changes in kidney function.
• Tissue biopsy. Taking a tissue sample of the skin or kidney can be examined to see if there are any signs of inflammation and damage.
• Antiphospholipid Antibodies (APLs). This antibody is present in about 60% of patients with lupus. It can be used to help identify women with lupus that have certain risks, such as blood clots and miscarriage, that require preventive treatment and monitoring.
• Imaging tests. These include chest x-rays and echocardiograms that are used to check for inflammation or fluid buildup in or around your heart and lungs.

What are some Lupus treatment options?

There is no cure for lupus so your treatment plan goals will be to manage your symptoms, relieve and prevent flare-ups, reduce organ damage, and improve your quality of life.

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as Advil/Motrin (ibuprofen) and Aleve (naproxen) are used to relieve swelling and inflammation.
• Corticosteroids. Sterapred (prednisone), Decadron (dexamethasone), and Medrol (methylprednisolone) are used to reduce inflammation in patients with lupus flare-ups.
• Antimalarial drugs. These drugs such as Plaquenil (hydroxychloroquine) are commonly used to treat malaria. They are also used to treat lupus symptoms such as rashes and joint pain They can also prevent symptom flare-ups.
• Immunosuppressants. These medications help suppress or slow down your overactive immune system. They are usually used in severe cases of lupus. Examples include Sandimmune (cyclosporine), Cytoxan (cyclophosphamide), Trexall (methotrexate), CellCept (mycophenolate mofetil), and Imuran (azathioprine).
• Biologics. Benlysta (belimumab) and Saphnelo (Anifrolumab-fnia) are 2 monoclonal antibodies that are approved to treat lupus. They work by blocking a protein in your body that is important for your immune response.

Alternative and complementary treatments

In addition to medications, your healthcare provider may also recommend some treatments or lifestyle changes to help manage your lupus symptoms, including:

• Avoiding or reducing your exposure to UV light
• Eating a healthy diet
• Supplements such as vitamin D, vitamin C, DHEA, and omega-3 fatty acids in fish oil
• Regular exercise
• Quit smoking
• Acupuncture

What is the best medication for Lupus? 

The best medication for the treatment of Lupus will depend on the individual’s specific medical Lupus, medical history, medications that the individual is already taking that may potentially interact with Lupus medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter Lupus medications approved by the Food and Drug Administration (FDA).

Best medications for Lupus

Your healthcare provider will determine the right dosage based on your response to the treatment, medical Lupus, weight, and age. Other possible side effects may exist; this is not a complete list.

What are the most common side effects of Lupus medications?

As with all medicines, those used for Lupus will have some side effects, depending on the class you are taking:

• NSAIDs’ most common side effects include nausea, upset stomach, indigestion, and heartburn.
• Immunosuppressants can cause an increased risk of infection, headache, nausea, vomiting, and increased hair growth.
• Biologics can increase your risk of serious infection, as well as cause injection site reactions, nausea, and headaches.
• Corticosteroids’ side effects include increased appetite, weight gain, acne, increased risk of infections, and mood changes.

What are some home remedies for Lupus?

It is important to take an active role in your treatment. There are certain changes you can make to your daily life that can help reduce symptoms, prevent flare-ups, and improve your quality of life.

Lupus flare-up prevention

• Eat a healthy diet including fruits, vegetables, and whole grains.
• Exercise regularly as tolerated.
• Limit your sun exposure or wear sunscreen since sunlight can cause rashes and flares.
• Quit smoking.
• Avoid alcohol.

Frequently asked questions about Lupus

What are some complications of lupus?

Lupus causes inflammation that can affect every part of your body and lead to other problems such as:

• Kidney problems (lupus nephritis)
• Seizures and memory problems due to damage to your central nervous system
• Heart issues such as pericarditis (inflammation of the lining around the heart muscle)
• Blood clots
• Anemia
• Infection from lupus complications and from some medications used to treat the disease
• Pleurisy (inflammation of the tissues that line the lungs and chest cavity)
• Osteoporosis, usually due to long-term steroid use

Who gets lupus?

While anyone can get lupus, risk factors for developing this condition include:

• Having a family history of lupus
• Being a woman (90% of those affected are women)
• Being African-American, Native American, Pacific Islander, or Asian American
• Viral infections
• Certain medications
• Overexposure to UV rays
• Smoking

Is there a cure for lupus?

No. Lupus is a chronic disease and there is currently no cure. There are effective treatments that can reduce symptoms and prevent complications, but the disease will never completely go away.

What are some things you should avoid if you have lupus?

If you have lupus there are certain foods and medications that you should try to avoid that have been shown to trigger lupus symptoms or worsen complications, including:

• Alfalfa
• Garlic
• Foods high in saturated and trans fats
• Alcohol
• Salt
• Bactrim/Septra (sulfamethoxazole/trimethoprim)
• Echinacea

Related resources for Lupus

• About lupus. Lupus Research Alliance
• Lupus overview. Mayo Clinic
• What is lupus? WebMD
• Lupus summary. MedlinePlus
• Everything you need to know about lupus. Healthline
• Lupus symptoms and causes. Cleveland Clinic
• Lupus. Overview, symptoms, and causes. National Institute of Arthiritis and Musculoskeletal and Skin Diseases
• Types of lupus. Us in lupus
• 5 foods to avoid if you have lupus. John Hopkins Lupus Center