Systemic Lupus Erythematosus
Symptoms of Lupus continued...
The range and effectiveness of treatments for lupus have increased
dramatically, giving doctors more choices in how to manage the disease. It is
important for the patient to work closely with the doctor and take an active
role in managing the disease. Once lupus has been diagnosed, the doctor will
develop a treatment plan based on the patient's age, sex, health, symptoms, and
lifestyle. Treatment plans are tailored to the individual's needs and may
change over time. In developing a treatment plan, the doctor has several goals:
to prevent flares, to treat them when they do occur, and to minimize organ
damage and complications. The doctor and patient should reevaluate the plan
regularly to ensure it is as effective as possible.
NSAIDs: For people with joint or chest pain or fever, drugs
that decrease inflammation, called nonsteroidal anti-inflammatory drugs
(NSAIDs), are often used. While some NSAIDs, such as ibuprofen and naproxen,
are available over the counter, a doctor's prescription is necessary for
others. NSAIDs may be used alone or in combination with other types of drugs to
control pain, swelling, and fever. Even though some NSAIDs may be purchased
without a prescription, it is important that they be taken under a doctor's
direction. Common side effects of NSAIDs can include stomach upset, heartburn,
diarrhea, and fluid retention. Some people with lupus also develop liver,
kidney, or even neurological complications, making it especially important to
stay in close contact with the doctor while taking these medications.
Antimalarials: Antimalarials are another type of drug
commonly used to treat lupus. These drugs were originally used to treat
malaria, but doctors have found that they also are useful for lupus. A common
antimalarial used to treat lupus is hydroxychloroquine (Plaquenil)*. It may be
used alone or in combination with other drugs and generally is used to treat
fatigue, joint pain, skin rashes, and inflammation of the lungs. Clinical
studies have found that continuous treatment with antimalarials may prevent
flares from recurring. Side effects of anti-malarials can include stomach upset
and, extremely rarely, damage to the retina of the eye.
* Brand names included in this publication are provided as examples only,
and their inclusion does not mean that these products are endorsed by the
National Institutes of Health or any other Government agency. Also, if a
particular brand name is not mentioned, this does not mean or imply that the
product is unsatisfactory.
Corticosteroids: The mainstay of lupus treatment involves
the use of corticosteroid hormones, such as prednisone (Deltasone),
hydrocortisone, methylprednisolone (Medrol), and dexamethasone (Decadron,
Hexadrol). Corticosteroids are related to cortisol, which is a natural
anti-inflammatory hormone. They work by rapidly suppressing inflammation.
Corticosteroids can be given by mouth, in creams applied to the skin, or by
injection. Because they are potent drugs, the doctor will seek the lowest dose
with the greatest benefit. Short-term side effects of corticosteroids include
swelling, increased appetite, and weight gain. These side effects generally
stop when the drug is stopped. It is dangerous to stop taking corticosteroids
suddenly, so it is very important that the doctor and patient work together in
changing the corticosteroid dose. Sometimes doctors give very large amounts of
corticosteroid by vein over a brief period of time (days) ("bolus" or
"pulse" therapy). With this treatment, the typical side effects are
less likely and slow withdrawal is unnecessary.