There's no cure for lupus at present, but the condition is most often very treatable and usually responds well to a number of different types of drugs – especially when treatment is started in the early stages of the disease.
The drugs used to treat lupus will depend on the severity of your disease and which parts of your body are affected. Your treatment will probably be changed or adjusted as your symptoms flare-up up or improve.
Most of the drugs described below were originally developed for other diseases but were later found to be useful in lupus.
Two newer drugs are now sometimes used for treatment of severe lupus – rituximab and belimumab. These are biological therapies which act against B-cells – the blood cells which produce antibodies. Research is continuing to find out which patients respond best to these drugs.
Non-steroidal anti-inflammatory drugs
Examples: naproxen and ibuprofen
- reduce inflammation
- help with symptoms in your joints
- often used for short periods.
Read more about non-steroidal anti-inflammatory drugs (NSAIDs).
- reduce inflammation
- used alone or with steroid creams for skin rashes
- also useful as a treatment for fatigue and joint pain
- can help to lower cholesterol and control kidney disease.
- used for short periods for complications such as pleurisy or pericarditis
- may also be used as a longer-term treatment for other problems, such as kidney inflammation or severe blood problems.
When taking steroid tablets you must carry a steroid alert card, which records your dose and how long you've been taking them. If you become ill, or are involved in an accident in which you're injured or become unconscious, it's important for the steroid to be continued. The dose might also need to be increased because the treatment may prevent your body from being able to produce enough natural steroids in response to stress, as normally happens in this situation. Your doctor, rheumatology nurse specialist or pharmacist can give you a steroid card.
Read more about steroid tablets.
Disease-modifying anti-rheumatic drugs (DMARDs)
Examples: azathioprine, ciclosporin, cyclophosphamide, methotrexate and mycophenolate
- used to dampen down the overactive immune system
- may need to be taken for long periods, though the dose may be reduced if the disease becomes less active
- will often control high blood pressure and have the added benefit of helping to prevent kidney problems
- may be used along with steroid tablets to allow steroid dose to be reduced.
Examples: rituximab and belimumab
- remove or reduce the activity of B-cells (a type of white blood cell that produces harmful autoantibodies)
- used for patients with lupus when conventional DMARDs aren't effective, though research into their effect is continuing.
If you're being prescribed a biological therapy, such as rituximab, it's recommended that you carry a biological therapy alert card, which you can obtain from your doctor or rheumatology nurse specialist. Then if you become unwell, anyone treating you will know that you’re on a biological therapy and that you're therefore at risk of its side-effects, including injections.
- can be injected into a muscle or vein as immediate treatment to help control a flare-up
- can also be injected into the scalp if hair loss is a problem (though often the hair grows back by itself when the disease is brought under control).
Read more about steroid injections.
- may be used to control high blood pressure.
Treatments for Raynaud's phenomenon
Examples: nifedipine tablets and iloprost injections
- may be used to widen your blood vessels to improve circulation.
What about side-effects?
All drugs have some potential side-effects, and you and your doctor will need to balance the risk of side-effects with the need to control your symptoms. Sometimes this may mean taking additional medications to protect against the side-effects of others.
NSAIDs can sometimes have side-effects, but your doctor will take precautions to reduce the risk of these – for example, by prescribing the lowest effective dose for the shortest possible period of time.
NSAIDs can cause digestive problems, including:
- stomach upsets
- damage to the lining of the stomach.
In most cases, therefore, an additional drug called a proton pump inhibitor (PPI) will be prescribed, which will help to protect the stomach.
There is an increased risk of heart attack or stroke with taking NSAIDs. Your doctor will be cautious about prescribing NSAIDs, especially for long periods, if there are other factors that may increase your overall risk, for example:
- circulation problems
- high blood pressure
- high cholesterol
If you're taking steroid tablets at high doses or for long periods of time, you may be given bisphosphonates, calcium tablets and vitamin D tablets to guard against osteoporosis. You may be given DMARDs instead of high doses of steroids. These should be avoided, however, if you have lupus in your kidneys as DMARDs can cause further kidney problems.
If you have lupus, and especially if you're on a DMARD or biological therapy, you'll be more prone to infection. Take care to avoid close contact with people with active infectious diseases like chickenpox or people who have recently been in hospital.
You shouldn't have live vaccines if you're on more than 10 mg of prednisolone daily or if you're on certain DMARDs or biological therapies. These vaccines include:
- yellow fever
- live typhoid
- live oral poliomyelitis (polio).
You should think about this when you're planning a holiday. Check with your doctor if you think you might need these vaccinations.
Pneumovax (which gives protection against the most common cause of pneumonia) and yearly flu vaccines are well tolerated and recommended.
If there's a significant build-up of fluid in the lining tissues of your heart or lungs, this may need to be drained using a needle and syringe.
Rarely, some people with lupus develop kidney failure, which may require dialysis or a kidney transplant. However, severe kidney damage can usually be prevented by early diagnosis and treatment of lupus. It's important therefore to take any medications as prescribed by your doctor.