Treatment & Prognosis
Because lupus is such an individual disease, treatments can vary greatly from patient to patient depending on symptoms, lab findings, and severity of the disease.
Generally, the aim of drug therapy is to address the underlying cause of the symptoms, that is, to reduce the abnormal activity of the immune system. Additional medications may be prescribed to help with painful or uncomfortable symptoms.
Some of the medications used to control lupus include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation
- Antimalarial drugs like hydroxychloroquine, which, when given orally in low doses on a daily basis, are highly effective in reducing pain and inflammation
- Immunosuppressant drugs, such as Cytoxan, Imuran (azathioprine) and methotrexate, that suppress your bodies’ immune system, including the overactive parts that are causing pain and tissue damage
- Corticosteroids such as prednisone, which can be highly effective in reducing inflammation; topical/intralesional corticosteroids can be used for skin lesions
Some of these medications come with potentially serious side effects, and would only be prescribed in certain cases, for example those that include major organ involvement (heart, lung, kidney, or central nervous system).
If you are prescribed any of the medications that have potentially serious side effects, you will be monitored closely by your doctor.
Certain forms of lupus may require high doses of corticosteroids; however, due to the risk of dependence, and potentially severe side effects from relatively low doses, extreme care is taken with this form of therapy.
Some other medications often used in treating the symptoms of lupus include:
- Antibiotics for patients who develop infections due to having a depressed or altered immune system
- Anti-depressants to help patients with depression and anxiety
- Vitamin D and calcium to support healthy bones
- Blood pressure medications
- Pain control medications
It is recommended that patients with SLE address certain factors that can adversely affect their health, including:
- Avoiding direct sunlight, through the use of extra clothing, sunscreen and camouflage cosmetics with SPF 30 or greater, and avoiding the hottest part of the day (10am-4pm)
- Smoking cessation, which allows antimalarials to work better
- Reducing or eliminating medications that have thiazides and sulfonylureals (sulfa drugs) which can worsen skin disease
- Getting adequate rest and reducing stress
- Staying active
Patients with lupus are advised to work closely with their doctor when planning a pregnancy, as there are added risks to both mother and baby.
- For example, some babies of mothers with SLE have neonatal SLE at birth, and miscarriages are more common in patients with SLE.
- In situations where the patient is in remission, there are some studies that suggest a pregnancy can increase the risk for disease flare-ups, particularly if the disease has been active in the six months.
- It is possible to have a successful pregnancy with SLE, however, careful planning, monitoring and care are necessary for the health of both mother and child.
The prognosis for patients with lupus is steadily improving.
The majority of cases consist of symptoms that can be managed well with highly tolerable medications, minor lifestyle modifications and precautions. However, in a minority of cases, SLE can progress over time to more severe manifestations of the disease, which can pose serious consequences for the individual unless more aggressive forms of drug therapy – which also may pose health risks to the individual – are undertaken.
In rare cases, lupus patients can experience severe or life-threatening complications and consequences of disease progression, such as septic arthritis (infection of a joint), osteonecrosis (interruption of blood flow and subsequent death of a bone), and even death, arising from infection, kidney failure, cardiovascular disease, or inflammation of the central nervous system. Kidney failure, due to a variety of related and complicating factors, now poses one of the greatest risks to most lupus patients.
The good news is that lupus outcomes have been steadily improving over the last 30 years; patient deaths are now often secondary to the actual disease itself, most often due to complications from more toxic forms of drug treatment, pre-existing lifestyle factors, and genetic or environmental determinants that are exacerbated by lupus.
Furthermore, there are new medications available for treating lupus, and many more that are in late stages of development.
In summary, lupus is a serious disease that manifests in many ways and over time, requiring constant monitoring and management with your physician.