Treating Lupus

 

This is the third article in Pain.com’s series of articles about lupus. The subject of this article is treating systemic lupus erythematosus (SLE). There is no cure for SLE, but the disease can be managed with a comprehensive treatment plan. The prognosis for patients with lupus has increased drastically due to medical advances, and many people with lupus have a normal life span and rarely need to be hospitalized for their condition. However, lupus is a serious disease than can affect the vital organs, so developing and following an effective treatment plan is extremely important. Treatment for lupus includes medications to control the inflammatory response, medications to control specific symptoms that arise and emergency treatments for potentially life-threatening complications of lupus.

In general, certain types of medication can help control lupus in patients who are not suffering from an aggressive form of the disease. Prescription-strength or over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can help control inflammation and pain caused by SLE, as well as reduce fever. It is important to talk to your doctor about which NSAIDs to take and how often to take them, because long-term use of NSAIDs can put you at risk for side effects like bleeding in the gastrointestinal tract and kidney problems. People with lupus may be more prone to these side effects than people without lupus, so it is important for treatment to be monitored by a medical professional.

Low-dose corticosteroids may be used in lupus patients that need additional medication to control their inflammation. Low-dose corticosteroids are usually given as a cream to control outbreaks of skin rashes or tablets that are taken orally. Corticosteroids have side effects, such as weight gain and loss of bone mineral density, if they are used over a long period of time.

Drugs that are normally used to treat malaria can be effective in treating lupus symptoms, even though malaria and lupus are completely different diseases. Antimalarial drugs may even be effective in preventing attacks of SLE in some people.

Different combinations of drugs may be used to treat lupus symptoms in different individuals, as treatment plans are customized to particular cases of SLE. The treatments mentioned above are usually successful in treating lupus symptoms such as pericarditis, pleurisy, joint pain, muscle pain, fatigue and skin rashes. Skin rashes can also be prevented by avoiding sun exposure. For muscle pain, joint pain and skin rashes that do not clear up despite treatment with low-dose corticosteroids, NSAIDs or antimalarial drugs, a drug called belimumab may be effective in controlling these symptoms. Belimumab is an antibody that attacks a protein that activates certain cells in the immune system that attack a person’s own body during flare-ups of lupus. In other words, this drug intercepts the protein that turns these cells on, so that they are less likely to attack a person’s own body.

In more aggressive cases of lupus, more extreme treatments are necessary to control the damage to vital organs, such as the heart, nervous system and kidneys. The main two types of aggressive treatments are high-dose corticosteroids and immunosuppressive therapy. High-dose corticosteroids are either given orally or as an intravenous injection. High doses of corticosteroids have more side effects than low-dose corticosteroids. High-dose corticosteroids are used on a temporary basis to control serious lupus symptoms and then discontinued when the symptoms of the lupus attack subside.

Drugs that suppress the immune system can help treat autoimmune diseases, such as SLE, but suppressing the immune system makes a person more susceptible to certain infections and certain types of cancer. These drugs also carry some risk of a person developing liver damage or becoming infertile. The two immunosuppressive drugs that are most commonly used to treat SLE are azathioprine and cyclophosphamide. A drug called methotrexate, which is normally used to treat another autoimmune condition called rheumatoid arthritis, may also be used to treat aggressive lupus. Mycophenolate is a drug that is specifically effective in cases of kidney problems caused by lupus. Corticosteroids or immunosuppressive drugs may be used alone or in combination to treat aggressive cases of lupus.

Some other treatments may be effective in treating SLE, but are still being investigated in clinical trials. One experimental treatment is a hormone called dehydroepiandrosterone (DHEA). Studies have not yet reached a verdict about using DHEA to treat lupus. Intravenous immunoglobulin, a type of antibody therapy, may also be helpful in treating SLE. A drug called rituximab is another immunosuppressive drug that is currently being investigated for treating lupus.

Another promising treatment that is under development and investigation uses stem cell therapy to treat lupus. Stem cell therapy for lupus would involve collecting adult stem cells from a patient, suppressing the patient’s immune system and then transplanting the stem cells back into the patient’s body. Theoretically, this treatment should be able to “reboot” a patient’s immune system. In the future, stem cell therapy could possibly lead to a cure for lupus and other autoimmune diseases.