How Is Lupus Treated?

Lupus is a chronic (long-term) autoimmune condition that occurs when the immune system attacks healthy tissues by mistake, causing inflammation throughout the body. This inflammation damages tissues and organs including the skin, lungs, kidneys, blood vessels, and joints. There is no cure for lupus, but treatment and lifestyle changes help manage the condition. 

Everyone experiences lupus a little differently. That said, treatment for lupus will be tailored to your individual symptoms, the severity of the condition, and overall health. The primary goals for lupus treatment are to:

• Reduce symptoms or achieve remission (a period when you experience little to no symptoms)
• Prevent organ damage and other complications 
• Improve quality of life

If you receive a diagnosis for lupus, it’s important to keep in contact with your primary care provider. Your provider will work with you to set up routine check-ups, order lab tests to check how treatment is working, and make any adjustments to your treatment plan, if necessary. 

Treatments by Lupus Stage

For the most part, your treatment options will depend on the severity of your condition. However, there are some standard anti-malarial treatments that your healthcare provider may prescribe you regardless of what stage of lupus you are in.

These treatments include:

Most people who take these medications tolerate them well, as serious side effects are generally rare. 

However, your healthcare provider will continue to monitor you for the possibility of toxic retinopathy—a severe side effect of hydroxychloroquine that may damage your vision health. To help manage your risk of toxic retinopathy, your provider will likely advise routine vision screenings and adjust your medication dosage, if necessary.

Treatment for Mild Lupus

People with mild lupus may experience more fatigue, joint pain, and stiffness. In addition to hydroxychloroquine, your healthcare provider may recommend the short term use of nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids to your treatment plan.

NSAIDs are medications that help treat inflammation and reduce symptoms such as pain, fever, and swollen joints. Advil and Motrin (ibuprofen) and Aleve (naproxen) are common NSAIDs for lupus treatment.

Corticosteroids (commonly known as steroids) are medications that help lower inflammation in the body. Steroids come in different forms and can be taken:

• Orally via a liquid or pill that you swallow 
• Topically through a cream that you apply to the skin
• Through an injection 
• Intravenously (IV) from an infusion that your provider will administer into your vein

Your healthcare provider will generally prescribe you a daily steroid medication. The most common corticosteroid is Rayos or Sterapred (prednisone).

Steroids are potent (powerful) medications that are not risk-free. Side effects of steroids include weight gain, thinning bones (osteoporosis), and stretch marks. Your healthcare provider may start you on the lowest dose and adjust as needed based on your inflammation-related symptoms.

Treatment for Moderate and Severe Lupus

For moderate lupus, your healthcare provider will prescribe hydroxychloroquine, a short-term dose of prednisone, and an immunosuppressant. 

Since lupus is an autoimmune disease, your immune system becomes overactive when you are experiencing symptoms. Immunosuppressants help to suppress (or calm down) your immune system, which can help reduce inflammation and the severity of your symptoms.

Your provider can prescribe you an immunosuppressant to take either orally (by mouth) or through intravenous (IV) infusion. The most common types of immunosuppressants for lupus are:

• Imuran (azathioprine) 
• Benlysta (belimumab)
• Saphnelo (anifrolumab)
• Cellcept (mycophenolate)
• Cytoxan (cyclophosphamide)
• Rituxan (rituximab)

Because immunosuppressants work by suppressing the immune system, they can also lower your body’s ability to fight off infections. As a result, these medications can cause serious side effects such as recurring infections, bone marrow loss, and abnormal liver test results. Your healthcare provider will likely order routine lab work to monitor your health while you are taking immunosuppressants.

Lifestyle Changes

Treating lupus requires a well-rounded approach. In addition to drug therapy, lifestyle changes can also help you better manage your symptoms. Your provider may recommend one or more of the following lifestyle changes:

• Limit or avoid sun exposure: Exposure to ultraviolet (UV) light may lead to or worsen existing lupus-related skin rashes. It’s good practice to avoid exposure to direct or reflected sunlight and sources of UV light, such as fluorescent or halogen lights. You may also consider using sunscreens that block UV-A and UV-B with a sun protection factor (SPF) greater than 55.
• Maintain a well-balanced diet: Your meals should be made up of fruits, vegetables, and whole grains. If your diet is lacking in vitamins, consider a daily multivitamin. If you have hypertension (high blood pressure) or nephritis (kidney inflammation), monitor your salt intake. Eating nutritious foods that are right for you can improve your overall well-being and support your immune system. 
• Stay physically active: Exercise helps keep your joints flexible and lowers the risk of heart disease and stroke. Talk to your healthcare provider about physical activity or exercise that is best for your condition. Remember to incorporate rest days into your exercise schedule.
• Stop smoking: Cigarette smoking can worsen inflammation and increase your risk of heart disease—a complication related to lupus.
• Stay up-to-date on immunizations: Based on your medical history, a healthcare provider will discuss different immunizations or vaccines that can reduce your risk of developing other infections. Immunizations may include pneumococcal (strep throat or meningitis), varicella (chickenpox), and flu vaccines.

Living With and Managing Lupus

Lupus is a complex condition that looks different from person to person. Lupus ranges from mild to severe and can progress rapidly to several organs, especially without treatment. The survival rate for lupus has gotten better over the years thanks to more awareness of the disease, earlier diagnosis and treatment, and more advanced research on lupus-related medication.

Despite progress, people living with lupus still face challenges related to the condition. This includes managing the side effects of medications, unpredictable flares, increased risk for other health conditions, and disability. However, the following tips can still help you live a long and healthy life:

• Recognize what triggers your flares 
• Follow your treatment plan and talk with your provider if you need adjustments 
• Build a support system of people you trust
• Lower your stress levels
• Get enough sleep and make time for breaks throughout the day 

A Quick Review

Lupus is a complex, autoimmune condition that requires a well-rounded approach to treatment and care. While there is no cure for lupus, treatment can help you reduce symptoms, prevent organ damage and serious complications, and improve your quality of life.

Your healthcare provider can help you develop a treatment plan that is best for your symptoms, the severity of your condition, and your overall health. Options for treatment generally include medications and lifestyle changes.