Treatment Options for Lupus

By Mary Anne Dunkin | June 27, 2022

Controlling lupus, or systemic lupus erythematosus (SLE), may involve medication, physical therapy, a healthy diet and a healthy lifestyle. Treatment for lupus depends on its severity and the specific organs involved. Lupus affecting only the skin or that involves the kidneys (lupus nephritis), blood vessels (vasculitis) or central nervous system may require additional medications and other treatments. Work closely with your doctor and health care team to create a treatment plan that works well for you.

The goal of treatment for lupus is to

• Control inflammation and prevent damage to organs.
• Prevent or control disease complications and flares.
• Relieve pain and other symptoms.
• Increase energy levels and reduce fatigue.
• Preserve function and help you continue normal daily activities.

Medications

Medications are an essential part of treating lupus. Drugs that reduce inflammation and slow or stop the destructive immune response can prevent damage to organs and reduce complications that can come with the disease. Other medications are used to relieve pain and other specific symptoms. Medications may be added or altered to control flares, when symptoms worsen. They may include fever, joint or muscle pain or fibromyalgia (widespread body pain), fatigue or rash. New symptoms or organ damage also may develop during a flare. Your doctor may prescribe or recommend the following:

Drugs to Reduce Inflammation and Tissue Damage

• Corticosteroids. Similar to the cortisone your body makes naturally, corticosteroid medications are potent anti-inflammatories. Your doctor may prescribe high doses to quickly get inflammation under control, and then taper them when it’s well controlled. Many people with lupus take a low dose of the corticosteroid drug prednisone indefinitely.
• Antimalarials. Drugs originally developed to treat malaria are commonly prescribed to reduce flares and relieve pain and other symptoms, including skin rashes. Your doctor may prescribe an antimalarial drug along with other drugs to treat lupus. The most common of these is hydroxychloroquine.
• Immunosuppressive drugs. These drugs work in different ways to suppress or modify the immune response in lupus, which mistakenly attacks healthy tissues. Commonly prescribed immunosuppressive drugs for lupus include:
  • Methotrexate 
  • Mycophenolate mofetil (CellCept) 
  • Azathioprine (Imuran) 
  • Cyclophosphamide (Cytoxan) 
  • Voclosporin (Lupkynis) (lupus nephritis only)
• Biologics. Biologics are genetically engineered proteins that target specific parts of the immune system that fuel inflammation. Two biologic drugs are approved to treat lupus:
  • Belimumab (Benlysta). Belimumab works by blocking the activity of a protein called B-lymphocyte stimulator (BLyS), which prolongs the survival of B cells and contributes to the production of autoantibodies in lupus.
  • Anifrolumab (Saphnelo). A monoclonal antibody that works to block interferon 1 — an immune system protein that is over-activated in people with lupus — anifrolumab is approved to treat people with moderate to severe lupus who are also taking other medications for lupus. 

Drugs to Relieve Pain

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs). In low doses, NSAIDs can be effective at relieving pain. At higher, prescription doses they can also help control inflammation. It’s important to note that if you have kidney disease along with lupus, you should not take NSAIDs. Two NSAIDs, ibuprofen (Advil, Motrin) and naproxen (Aleve), are available over the counter. Around a dozen others are available by prescription.
• Analgesics. Over-the-counter acetaminophen (Tylenol) may be helpful for pain relief, particularly if kidney involvement makes it inadvisable to take NSAIDs.

Exercise And Physical Therapy

When pain and fatigue make it difficult just to get off the sofa, exercise may be the last thing on your mind, but physical activity is one of the best things you can do for your lupus. When beginning a new exercise, start slowly. Low-impact, aerobic activities such as walking, swimming or riding a stationary bicycle are good places to start.

A physical therapist teach you exercises to reduce pain and stiffness, strengthen muscles, increase stamina and improve flexibility to help you feel and function better.   

Make Healthy Lifestyle Changes

Adopting healthy lifestyle habits can help you live better with lupus, maintain your daily activities and potentially reduce your risk of lupus flares. If job and household tasks are difficult or cause pain, work with an occupational therapist who can provide individualized advice and assistive devices.

Practice Sun Protection

For many people with lupus, exposure to ultraviolet (UV) rays, both from artificial light or sunlight, can worsen the disease or trigger flares.

• Always wear sunscreen of 30 SPF or higher, particularly if you are going outdoors. Reapply every two hours.
• Wear wide-brimmed hats, sunglasses and tightly woven clothes when going outdoors drug daylight hours.
• Use UV-blocking shades over your windows.

Maintain A Healthy Weight

Research shows that women with lupus who are obese are more likely to have limitations on daily activities and become disabled. If you are overweight, losing weight is important to managing lupus and preventing other diseases that can occur along with it.

Seek Emotional Wellness

Feeling sad, worried or anxious are all common reactions to having a chronic disease. The body-wide inflammation may even contribute to depression. But you can learn to cope with lupus, improve your mood and ease worries.

Lupus symptoms can affect daily activities — and relationships. Ask for help when you need it and let people in your life know when you aren’t able to do activities you used to. The same is true of sex. Discussing your needs with your partner and finding modifications will help you overcome almost any difficulty.

Make Workplace Accommodations

Many people with lupus can continue to have a productive, active work schedule. But if pain, stiffness and fatigue limit your ability to do certain tasks on your job, simple modifications to those tasks, your schedule or your workspace may help.

• Avoid lifting, stooping or remaining in cramped or bent positions.
• Raise your computer monitor to eye level to protect your posture.
• Change positions often and move around at least once an hour.
• Take short rest periods throughout the day.

Practice Pain-Relief Techniques

In addition to taking pain-relieving medications as your doctor prescribes, you can take these measures on your own to manage pain:

• Activity pacing. Lighten your schedule and ask for help when you need to. Take breaks during the day to save energy and protect joints.
• Relaxation techniques. Relax your muscles and slow down your thoughts. Try deep breathing, guided imagery and visualization.
• Massage. Massage can help reduce pain, improve joint function and ease stress and anxiety.
• Use self-help devices. If fatigue and painful joints make daily tasks difficult, look for devices to make them easier.

Surgery

Sometimes joint surgery is necessary to improve function. Hip replacements are the most common joint surgeries for people with lupus. They are one of the most common joint surgeries performed, and generally are effective.