Lupus (Systemic Lupus Erythematosus) - Medications

Medications

Medications cannot cure lupus (systemic lupus erythematosus, or SLE), but they can control many symptoms and often can prevent or slow organ damage.

Because most lupus symptoms are caused by inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) and antimalarial medications are often enough to reduce symptoms.

Severe lupus may be treated with more aggressive medications that suppress the immune system, such as corticosteroids and immunosuppressive medications. Because these medications can cause serious side effects of their own, doctors prescribe and monitor them carefully.

Treatment for the skin rash that many people develop with lupus may include sunscreens, protective clothing, and avoiding sun exposure, as well as medications. Some medications work for some people but not for others, and some treatments have long-term side effects. More research is needed to determine which treatments are safest and most effective for skin rash.¹¹

Some lupus medications, like acetaminophen and prednisone, are considered safe during pregnancy. Others may not be. You may not be able to stop taking lupus medications after becoming pregnant, or you may need to start taking medication for a symptom flare. If possible, talk to your health professional before becoming pregnant about the effect lupus may have on your pregnancy.

Medication Choices

If you have mild disease or symptoms that affect your quality of life but don't have organ-threatening problems, your doctor may prescribe:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), sometimes in combination with antimalarial drugs.
• Antimalarial drugs such as hydroxychloroquine (Plaquenil).
• Low-dose corticosteroids and/or topical corticosteroid creams or ointments.

If you have more severe disease, your doctor may prescribe:

• Corticosteroids, such as prednisone.
• Immunosuppressive medications, such as azathioprine, cyclophosphamide, cyclosporine, mycophenolate mofetil, or methotrexate.

If you have previously had blood clots in a vein or artery (venous or arterial thrombosis), or have antiphospholipid antibody syndrome, which increases your risk of developing blood clots, your doctor may prescribe a blood thinner (anticoagulant). Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that is sometimes used to slow blood clotting in antiphospholipid antibody syndrome.

What To Think About

Medication treatment for lupus often involves reaching a balance between preventing severe, possibly life-threatening organ damage, maintaining an acceptable quality of life, and minimizing side effects.

Lupus treatment requires frequent monitoring of disease activity and medication side effects. Depending on how you respond to medications, your health professional may vary the dose and combinations of medications until you reach the best possible balance.

It may not be possible to completely eliminate all your symptoms for long periods of time, especially without medication side effects. For example, you may take a dose of medication that will control lupus enough to prevent organ damage, but you may still have symptoms such as mild skin rash, muscle aches, and joint pain. While higher doses of medications may relieve your symptoms, using them for a long time increases your risk of serious side effects. Your health professional will prescribe a dose that controls only the most serious, life-threatening symptoms and balances the risks of the medications with the benefits of controlling your symptoms.

People with lupus can go into spontaneous remission. If you experience an apparent remission, your doctor may taper or stop your medication.