bone, joint, and muscle disorders
Systemic Lupus Erythematosus (SLE)
Treatment of Lupus
Hydroxychloroquine(an antimalarial drug) for all affected people Nonsteroidal anti-inflammatory drugs for mild joint symptoms and corticosteroid creams for mild skin symptoms Corticosteroids, immunosuppressive drugs, and antimalarial drugs for severe disease Treatment of lupus depends on which organs are affected and how active the inflammation is. The severity of organ damage in lupus is not necessarily the same as the activity of inflammation. For example, organs may be permanently damaged and scarred from lupus that caused inflammation in the past. Such damage may be referred to as “severe,” even if the lupus is not active (that is, it is not causing any inflammation or any further damage at this time). The goal of treatment is to decrease the activity of lupus—that is, to decrease inflammation, which in turn should prevent new or further damage. is not given to people who have Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency (G6PD is an enzyme that protects red blood cells from certain toxic chemicals) because the drug can rapidly destroy red blood cells. People who take If lupus is not very active, causing mild joint or skin symptoms, treatment may not need to be intensive. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) often can relieve joint pain but should usually not be taken for long periods of time uninterrupted. Antimalarial drugs, such as People who have rashes or sores should stay out of direct sunlight and use strong Sunscreens (with a sun protection factor of at least 30) when outside. Rashes may also be treated with corticosteroid creams or ointments. If skin symptoms are not relieved by corticosteroid creams or ointments andhydroxychloroquine, people are given a combination ofhydroxychloroquineand quinacrine or a combination ofhydroxychloroquineandmethotrexate,mycophenolatemofetil, orazathioprine. People with frequent flares may also be givenbelimumab, a drug that reduces the activity of certain white blood cells involved in the autoimmune response in people with lupus. People who have severe, active lupus affecting the kidneys or brain, or causing lung bleeding are treated immediately, usually with the corticosteroidmethylprednisolonegiven by vein (see). Then people are given the corticosteroidprednisonetaken by mouth. The dose and duration of treatment depend on which organs are affected. The immunosuppressive drugcyclophosphamideis also given to suppress the body’s autoimmune attack.Mycophenolatemofetil is a commonly used alternative for severe lupus affecting the kidneys because it is as effective as and less toxic thancyclophosphamide. Other immunosuppressive drugs such asbelimumab,voclosporin, oranifrolumabalso help reduce lupus symptoms in some people. People who have end-stage kidney disease can undergo a kidney transplantation as an alternative to dialysis. People who have certain blood problems are given moderate or high doses of corticosteroids by mouth along with an immunosuppressive drug such asazathioprineormycophenolatemofetil. They may be given immune globulin (a substance that contains large quantities of many antibodies) by vein. People who are not helped by those treatments may be given the immunosuppressive drugrituximab. People who have nervous system problems may be givencyclophosphamideorrituximabby vein. People who develop blood clots are givenheparin,warfarin, or other anticoagulants (drugs that are sometimes called blood thinners). People with severe lupus often notice their symptoms have lessened after 4 to 12 weeks of treatment. Once the initial inflammation is controlled, a doctor determines the lowest dose of corticosteroids and other drugs that control inflammation (such as antimalarial drugs and immunosuppressants) that is needed to most effectively suppress inflammation over the long term. Usually, the dose ofprednisoneis gradually decreased when symptoms are controlled and laboratory test results show improvement. Relapses or flare-ups can occur during this process. For most people who have lupus, the dose ofprednisonecan eventually be decreased or discontinued. Because the long-term use of high doses of corticosteroids leads to many side effects, people who need to take high doses of corticosteroids for a long time are given an alternative drug such asazathioprine,methotrexate, ormycophenolatemofetil. People who take corticosteroids should be tested periodically and, if necessary, treated for Osteoporosis , which can occur with chronic corticosteroid use. People who take high doses of corticosteroids for long periods may be given (see Prevention ) and vaccines against common infections such as All people should be monitored closely by a doctor for heart disease. Common risk factors for Overview of Coronary Artery Disease (CAD) (for example, high blood pressure, diabetes, and high cholesterol levels) should be controlled as well as possible. Surgical procedures and pregnancy may be more complicated for people who have lupus, and they require close medical supervision. If pregnant, women should remain onhydroxychloroquinethroughout their pregnancy and may be given low-doseaspirinas well. Pregnant women who are at risk of blood clots may be givenheparin. Miscarriages and flare-ups during pregnancy are common. mofetil causes birth defects, women should wait to become pregnant until their disease has been well controlled for 6 months or longer (see Systemic Lupus Erythematosus (Lupus) ). Women who are in remission and who are thinking about becoming pregnant but who need to keep taking maintenance drugs are usually switched from 