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Treatment | Systemic Lupus Erythematosus | SLE
Being diagnosed with a chronic disease like lupus can be a little scary. The first thing is don’t panic. Reading information about lupus on the Internet can be a little scary. Take a deep breath. Remember, lupus is different for everybody. Most cases of lupus are mild.
If you have lupus or think you may have lupus, your family doctor should refer you to a rheumatologist. A rheumatologist is a specialist doctor who is an expert in treating arthritis and other inflammatory conditions. This type of doctor is in the best position to help you manage your condition. You may also be referred to other specialist doctors, depending on what your lupus looks like. For example, a dermatologist can help you manage skin symptoms of lupus, and a nephrologist can help you if your kidneys are affected.
Here are some recommendations on what you should do:
- Learn as much as you can about this disease. Education is very powerful and we’ve aimed to develop this RheumInfo website to be accessible and easy to understand for everyday people living with lupus and other forms of inflammatory arthritis
- Attend your rheumatologist appointments regularly
- Get your blood tests done as suggested by your rheumatologist
- Learn about the medications used to treat lupus. The RheumInfo website has many interactive and valuable tools to help you understand these medications and their impact on your disease
Treatment of lupus
Because lupus is such a variable disease, your treatment plan will be tailored just for you. There are effective treatments available that can help relieve the symptoms of lupus that bother you. Although they do not cure the disease, they can make living with lupus much more comfortable.
People with lupus can lead active and productive lives with the right kinds of treatment. Whatever treatment approach you choose it is essential to remember two key points: treat lupus early and treat it aggressively. Don’t wait. There are great treatments available that can help you get back to leading a full life.
Why is it important to treat lupus early?
If you have lupus, your immune system is activated or “turned on.” This can cause chronic inflammation. Over time inflammation can damage the body. An important goal of treatment is to get the inflammation under control as soon as possible to prevent damage from happening.
Here’s an analogy. Imagine you are sitting in your living room enjoying a nice cup of coffee. You look over to the kitchen and see a fire burning on the stove. What do you think you’ll do? One option is to just sit there and wait until the fire gets worse and spreads to the walls or the ceiling. The second option is to grab the phone, dial the fire department, and grab the fire extinguisher. You can think of lupus like a fire in your body. You want to get that fire put out as quickly as possible so it doesn’t damage your body.
Why is it important to treat lupus aggressively?
Using the same fire analogy, we’ve decided to call in the fire department. Now we need to make sure we have the right tools to put out the fire. We don’t want a bucket and water. We want a fire truck with a big hose. We might even want more than one fire truck. The faster we can get that fire out the better things will be in the long run.
Medications for lupus
There are many medications that can be used to treat lupus. The choice of medications will depend on your specific symptoms.
Fatigue is one of the most common symptoms in people with lupus. It’s also one of the most difficult symptoms to treat. Learning how to balance the demands in your life with your need to rest can go a long way. Medications such as prednisone can be helpful but also have side effects.
Swollen and inflamed joints may be treated with medications typically used for people with rheumatoid arthritis. These include Disease-Modifying Anti-Rheumatic Drugs (DMARDs) like methotrexate or hydroxychloroquine. For joints that ache but are not swollen, analgesics and/or a DMARD called hydroxychloroquine might help.
Chronic pain can be treated with a variety of medications – if one doesn’t work for you, try another.
Skin rash can be treated with topical medications applied directly to the skin. Other times, medications taken by mouth such as hydroxychloroquine, chloroquine, azathioprine, and mycophenolate can be useful. Prednisone can also be helpful to get skin rashes under control.
Hair loss is difficult to treat. The best solution is to keep lupus under control to prevent flares in the first place. Some medicines can also cause hair loss.
Like skin rash, mouth ulcers are treated by directly applying a medication to the sore. Sometimes prednisone can help.
When lupus affects the organs, treatment with DMARDs or biologics and high doses of prednisone may be needed to quickly get the inflammation under control.
For more information about specific medications used to treat lupus, refer to the “pictopamphlets” in the Medications section of this website.
Non-Steroidal Anti-Inflammatory Drugs or NSAIDs are medications that can help the pain and swelling of the joints caused by lupus. Luckily there are about 20 different anti-inflammatory medications available. So if one doesn’t work for you, try another.
Medications like prednisone can help control inflammation. Prednisone is a very effective medication to control many of the symptoms of lupus including fatigue, arthritis, skin rash, and mouth sores. High doses are typically used when any organs are involved.
In the short-term, prednisone works very well to rapidly control symptoms. When used for long periods of time, prednisone can have side effects. You should to discuss the risks and benefits of using prednisone with your rheumatologist. Some patients also benefit from cortisone injections directly into a joint. This should be discussed with your rheumatologist.
Analgesic medications only control pain. They do nothing to control the disease or to prevent damage to tissues such as joints. Analgesics can range from simple things like acetaminophen (Tylenol) to more potent narcotics like morphine.
The Disease Modifying Anti-Rheumatic Drugs (DMARDs) are medications that control symptoms and prevent long-term damage. Examples include methotrexate, hydroxychloroquine (Plaquenil), chloroquine (Aralen), leflunomide (Arava), azathioprine (Imuran), mycophenolate mofetil (Cellcept) or mycophenolic acid (Myfortic), and cyclophosphamide (Cytoxan).
DMARDs have been around for a long time and can work very well to control symptoms such as inflamed joints. They are also used in combination with prednisone when organs are involved. In some people, DMARDs such as hydroxychloroquine, chloroquine or azathioprine can be used to treat joint pain, skin rashes, and fatigue. Methotrexate and leflunomide (Arava) can be used to treat arthritis. When lupus is severe, medications like cyclophosphamide can be very effective in controlling the disease.
Most DMARDs take some time before they begin to work. Some people might not feel any effect when they first start taking DMARDs. Even if this happens, it’s important to keep taking DMARDs to help get the inflammation of lupus under control.
Biologics are the newest class of medications. These medications were specifically designed to treat immune disorders such as lupus. They are very effective and can make a big difference for people living with lupus. Like DMARDs, biologics control symptoms and prevent long-term joint damage.
Biologics are often given in combination with DMARDs or prednisone. This is because combination therapy has been shown to work better than treatment with either medication alone. Biologics may also help reduce the dose of prednisone that is used over the long-term.
Biologic therapies for lupus are aimed at a type of blood cell called B-cells. Two biologics are used to treat lupus: Rituxan and Benlysta. If one doesn’t work for you, your rheumatologist may suggest the other.
Chronic pain medications
Several different types of medication are available for the relief of chronic pain. Low doses of amitriptyline (Elavil), duloxetine (Cymbalta), gabapentin, pregabalin (Lyrica), and cyclobenzaprine are just a few examples. With so many chronic pain medications to choose from, if one doesn’t work for you, your rheumatologist can recommend another.
A drug called intravenous immunoglobulin (IVIG) is sometimes used in people with lupus. This drug doesn’t work in everyone. But when it does work in a given person, it can work extremely well.
Exercises for lupus
Exercise is important to overall health. Regular physical activity can also help you deal with fatigue and pain. The level and amount of exercise you can do depends on the activity of your lupus. A good rule of thumb is to aim for 20-30 minutes of physical activity every day. This can include walking or even more vigorous types of aerobic exercise.
A trained arthritis physiotherapist can help design an exercise program tailored to you and your needs. They can also help you choose mobility aids and teach you how to protect your joints if you have joint involvement.
Below are some useful articles on exercising with arthritis:
- Exercise and Arthritis: An article by arthritis physiotherapist, Marlene Thompson
- Exercising in a Flare: Another excellent article written by Marlene Thompson on how to cope with flares through your exercise routine.
Natural or Home Remedies for Lupus
There are no known natural remedies or complementary therapies that have been proven to help lupus in any significant way. However, it’s important to check with your rheumatologist to make sure that nothing interacts with your medication if you choose to use natural remedies or complementary therapies.
Diet for lupus
Questions about diet and lupus are very common. We all want to know what we can do to help ourselves. Can we change our diet to improve our immune system and help our lupus? Changing our diet gives us a sense of control over a disease which often seems to have a mind of its own.
Unfortunately, there is no diet that has been proven to significantly alter the course of lupus or other types of inflammatory arthritis. Following the basics of healthy eating can help improve health and well-being in everyone, including those with lupus. Keeping a healthy weight can help reduce the load on your weight-bearing joints. It can also help prevent or protect against weight gain that sometimes happens when people take prednisone for a long time.
Alcohol and lupus
Many of us like to share a glass of wine, a beer, or a spirit from time to time. Unfortunately, due to the nature of lupus, some people may turn to alcohol to help cope with the pain and distress. Alcoholic beverages are not an effective treatment for lupus. They can also interact with some medications. Examples include the DMARDs methotrexate, leflunomide, and azathioprine.
Smoking and lupus
Cigarette smoking, whether you have lupus or not, has no positive effects on any aspect of your health. Smoking and chronic inflammation are both recognized risk factors for heart disease. So if you are a smoker with lupus, quitting could be one of the best things you can do to improve your overall health.
Lupus is a different disease for different people. No two people have the same pattern of symptoms. Your rheumatologist will work with you to develop the best treatment plan to meet your unique needs. Different medications might be needed to target different symptoms. Sometimes several medications are used at the same time to treat lupus. Other times, one medication can relieve several different areas affected by lupus.