Information provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases
Diagnosing and treating lupus is a team effort of the patient and numerous specialists including a rheumatologist and clinical immunologist. As treatment progresses, nurses, psychologists, social workers, nephrologists, cardiologists, hematologists, endocrinologists, dermatologists, and/or neurologists, may also be needed. A primary care doctor, to help coordinate the care team and treat other problems as they arise, is also important.
The effectiveness of treatments for lupus has increased dramatically in recent decades, giving doctors more choices. It is important for the patient to work closely with the doctor and take an active role in managing the disease. The doctor will develop a treatment plan, given the patient’s age, sex, health, symptoms, and lifestyle, and has several goals — prevent and treat flares and minimize organ damage and complications. The doctor and patient should reevaluate the plan regularly.
Treatment Medications
- NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs), are often used alone or in combination with other types of drugs to control pain, swelling, and fever. Although some NSAIDs, such as ibuprofen and naproxen, are available over the counter it is important they are taken under a doctor’s direction. A prescription is necessary for other NSAIDs.
- Antimalarials: Originally used to treat malaria, doctors have found they also are useful for lupus. Used alone or in combination with other drugs, antimalarials are generally used to treat fatigue, joint pain, skin rashes, and inflammation of the lungs. Clinical studies have found that continuous treatment with antimalarials may prevent flares from recurring.
- Corticosteroids: Corticosteroids work by rapidly suppressing inflammation. Corticosteroids are administered orally, in topical creams, by injection, or intravenously (IV). Because they are potent drugs, the lowest dose required to achieve the desired benefit is used. Researchers are working to develop ways to limit or offset the use of corticosteroids to minimize side effects.
- Immunosuppressives: For some patients whose kidneys or central nervous systems are affected by lupus, an immunosuppressive drug may be used. Immunosuppressives restrain the overactive immune system by blocking the production of immune cells. These drugs may be administered orally or by IV. The risk for side effects increases with the length of treatment.
- BLyS-specific inhibitors: For lupus patients who are receiving other standard therapies including those listed above, BLyS-specific inhibitors such as belimumab, given by IV, may reduce the number of abnormal B cells thought to be a problem in lupus.
However, in studies conducted so far, African-American patients did not appear to respond significantly to belimumab. An additional study of this patient population is planned. The difference in response may be another indicator of the various ways lupus affects different patients.
Other Therapies: In some patients, methotrexate (an anti-rheumatic drug) may be used to help control the disease. Other treatments may include hormonal therapies, which may be useful for controlling lupus when other treatments haven’t.
Working closely with the doctor helps ensure that lupus treatments are as successful as possible. Because some treatments may cause harmful side effects, it is important to promptly report new symptoms and not stop or change treatments without talking to the doctor first. Additional medications, to treat problems such as high cholesterol, high blood pressure, or infection, may also be necessary.
Alternative and Complementary Therapies: Due to the potential for serious side effects as well as the nature and cost of treating lupus, many patients seek other therapies. An open dialogue between the patient and doctor about complementary and alternative therapies allows the patient to make an informed choice. Alternative approaches include special diets, nutritional supplements, fish oils, ointments and creams, chiropractic treatment, and homeopathy. Although these methods may not be harmful, no research to date shows that they affect the disease process or prevent organ damage. Some alternative or complementary approaches may help the patient cope with living with a chronic illness. If the doctor feels the approach is safe and has value, it can be incorporated into the treatment plan. However, it is important not to neglect regular health care or the treatment of serious symptoms.
For more information on lupus and other musculoskeletal health issues, visit www.niams.nih.gov. Join us next month for part five of the series on lupus.
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