Systemic Lupus Erythematosus

​Specialised clinics may result in better outcomes. Treatment of lupus depends on the signs and symptoms and which organs are involved.

Determining what medications to use requires a careful discussion of the benefits and risks with a rheumatologist. For adequate control of lupus, a rheumatologist may recommend more powerful drugs in higher doses initially but as the disease flare subsides, the dosage can usually be tapered off slowly and carefully. More aggressive lupus usually requires more powerful and long term drugs.

In general, when first diagnosed with lupus, your doctor may recommend the following medications:

• Non-steroidal anti-inflammatory drugs (NSAIDs)
  These include diclofenac acid (Voltaren) and the COX 2 inhibitors (Celebrex and Arcoxia). They are effective in controlling fever, muscle aches, joint pains and swelling.
  
• Antimalarial drugs
  Medications that are used to treat malarial can also be used to treat individuals with lupus. The two commonly known antimalarials are hydroxychloroquine (Plaquenil) and chloroquine. These medications have proved useful especially in lupus patients with joint and skin involvement. It has also proven to reduce lupus flares and help people with lupus to live longer.
  
• Corticosteroids
  These drugs counter the inflammation of lupus and are highly effective. They can have serious long term side-effects including weight gain, easy bruising, high blood pressure, diabetes, thinning of the bones (i.e. osteoporosis) and an increased risk of infection. Very often, doctors need to prescribe corticosteroids (e.g. prednisolone) in order to prevent permanent organ damage such as kidney failure or even death. To help reduce the side-effects, your doctor will try to find the lowest dose that controls the disease and prescribe the medicine for the shortest possible period of time.
  
• Immunosuppressive drugs
  These drugs suppress the immune system and may be useful in serious cases of lupus including patients with severe kidney or brain involvement. The most often used immunosuppressive drugs are cyclophosphamide, mycophenolate mofetil (cellcept) or mycophenolic acid and azathioprine. Cyclophosphamide is often given by injection into the veins. Potential side-effects include hair loss, feeling tired, nausea, change in menstrual cycle, increase risk of infection, low white cell count, liver injury, blood in urine and infertility.
  
• Mycophenolate mofetil or mycophenolic acid has proven to be effective in lupus affecting the kidneys and other major organs. It has fewer side-effects than corticosteroids and is proving to be an effective alternative to cyclophosphamide. These drugs should only be used under close supervision by a rheumatologist or a nephrologist (kidney specialist).