Medical treatment options for lupus

Treatment for lupus is very challenging and depends on your signs and symptoms because there will be periods of remission & periods of ‘flare-ups’. You need a careful discussion of the benefits and risks with your doctor as the treatment needs to customised specifically for you as your lupus behaviour may be different from other patients.  Sometimes, your doctor may put you on low dose treatment (maintenance) to reduce the risk of ‘flare-ups’.

These are the medications most commonly used to control lupus:

1) Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs such as Naproxen and Ibuprofen are used to treat pain, swelling and fever.  Potential side effects of NSAIDs include heart burn, fluid retention, stomach ulcers, kidney problems and increased risk of heart problems.

2) Antimalarial drugs

Hydroxychloroquine (Plaquenil) alters the immune system and can help decrease the risk of lupus flares. Potential side effects include stomach upset and rarely, damage to the retina of the eye. Regular (3-4 monthly) eye examinations are recommended when taking these medications.

3) Corticosteroids

Prednisone and other types of corticosteroids reduce the inflammation response caused by lupus and can be given by cream (for skin lesions), by mouth (most common method) or by injection (in severe cases). Side effects include weight gain (water retention), easy bruising, bone thinning (osteoporosis), high blood pressure, diabetes (or making diabetic control more difficult), cataracts and increased risk of infection.  The higher the steroid dose, the greater severity of the side-effects.

4) Immunosuppressants

This group of medication suppresses the immune system thus reducing immune cell attack on your own body.  Examples include Azathioprine (Imuran), Cyclophosphamide (Cytoxan), Mycophenolate mofetil (Cell Cept) and Methotrexate (Trexall). Potential side effects may include an increased risk of infection, liver damage, nausea & vomiting, hair loss, bladder problems, decreased fertility and an increased risk of cancer.

5) Biologics

Biologics such as Belimumab (Benlysta) and Rituximab (Rituxan) are injected into the body. Side effects include nausea & vomiting, diarrhoea, increase risk of infections and rarely, depression.

Regular blood tests and follow-ups with the doctor

It is essential to have blood tests to discuss your condition with your doctor on a regular basis (between 1-4 months depending on disease activity).  Your blood tests may include:-

1) Complete blood count (to check for anaemia, white cells and platelets)

2) Erythrocyte sedimentation rate (to check for inflammatory activity)

3) Kidney and liver function tests (as lupus can damage these organs)

4) Urinalysis (to check for infection and protein in the urine)

5) Antinuclear antibody (ANA) test. A positive test suggests a stimulated immune system

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