After receiving a lupus diagnosis, you’re likely wondering what treatment options are available to you. You may also ask the question, “Can lupus be cured?” Unfortunately, there is no cure for lupus.1 However, researchers and doctors have discovered several different classes of medication that can help manage symptoms and even target inflammation at its source to help treat the disease.
How Is Lupus Treated?
Lupus medications are mainly focused on targeting the inflammation that drives joint, skin, and organ damage. These therapies work either directly or indirectly on the immune system to alleviate the symptoms of lupus. Some can even help slow and prevent joint damage associated with the disease. Others help treat complications of lupus, such as lupus nephritis.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used anti-inflammatory medications for treating lupus. They work by targeting the inflammatory enzymes Cox-1 and Cox-2. These enzymes play a role in controlling inflammation through the formation of prostaglandins. Prostaglandins are involved in both your body’s normal functions and inflammatory response. When the Cox enzymes are blocked, they cannot make prostaglandins, which helps dampen inflammation in the body. As a result, pain and swelling go down.2
NSAIDs are available over-the-counter in pharmacies and grocery stores, or as a prescription written by your doctor. Examples of NSAIDs used to treat lupus include:
- Ibuprofen (Motrin®, Advil®)
- Naproxen (Aleve®, Naprosyn®)
- Meloxicam (Mobic®)
- Celecoxib (Celebrex®)
- Etodolac (Lodine®)
- Indomethacin (Indocin®)
Most NSAIDs on the market block both Cox-1 and Cox-2. Because Cox-1 is responsible for forming prostaglandins involved in normal body functions, you may experience some side effects while taking certain kinds of NSAIDs. These include:
- Upset stomach
- High blood pressure
- Easy bruising
- Fluid retention
- Inflammation of the stomach, known as gastritis
- Skin rashes, including light-sensitive rashes or hives
- Neck stiffness, especially when taking ibuprofen
NSAIDs are not an ideal treatment for everyone. In people with lupus nephritis (kidney damage caused by inflammation) NSAIDs may interfere with kidney function. On its own, lupus nephritis can cause high blood pressure and fluid retention, which may become worse with NSAIDs. If you have kidney damage, your doctor will discuss if NSAIDs are right for you. You may need extra monitoring while taking them.
Corticosteroids are synthetic (man-made) versions of steroid hormones found in the body. The steroid cortisol is an anti-inflammatory compound made by the adrenal glands that naturally reduces inflammation. Researchers developed cortisone and other corticosteroids as a mimic of cortisol to dampen inflammation. These medications are used to help treat many different autoimmune diseases, including lupus. Specifically, corticosteroids reduce joint pain, swelling, warmth, and tenderness in people with lupus. It’s important to note that corticosteroids are different from the anabolic steroids used by athletes to build muscle strength.3
Examples of corticosteroids used in treating lupus include:
- Dexamethasone (Decadron®)
- Methylprednisolone (Medrol®)
- Intravenous (IV) methylprednisolone (Solu-Medrol®)
The most commonly used corticosteroid for treating lupus is prednisone, which typically comes in pill form. If you’re having a flare, your doctor may recommend an intramuscular (IM) injection with triamcinolone to reduce inflammation without the effects of systemic corticosteroids (those taken by mouth or infused with an IV).
Corticosteroids come with several side effects, some of them more serious than others. As a result, they’re typically only prescribed after you’ve tried and failed other therapies to help manage your lupus. Your doctor will give you the lowest but most effective dose to help balance the benefits of the medication while limiting the side effects. Possible side effects of corticosteroids include:
- Weight gain due to an increase in appetite
- Easy bruising
- Development of a round-shaped face, known as Cushing’s syndrome
- Mood problems, including irritability, agitation, or mood swings
- Difficulty sleeping
- Upset stomach or formation of ulcers
- Irregular periods
- Facial hair growth
- Issues with underlying health conditions, such as high blood pressure or diabetes
- Increase in blood cholesterol levels
Long-term effects of corticosteroids include loss of bone density (osteoporosis), eye issues such as glaucoma or cataracts, pregnancy complications, and muscle weakness.
Antimalarial medications were originally developed to treat the parasitic infection malaria. However, doctors noticed that people with lupus who also received these medications saw improvement in their symptoms. Studies show that antimalarial drugs help improve lupus symptoms such as fever, fatigue, skin rashes, joint and muscle pain, and inflammation in the heart and lungs.4
Many people who take antimalarials stay on them for the rest of their lives. Research has found that lupus patients who take these medications live longer than those who don’t. They also help reduce flares by up to 50 percent and prevent lupus symptoms from spreading to other organs in the body.
There are three antimalarial drugs prescribed to treat lupus — hydroxychloroquine (Plaquenil®), quinacrine (Atabrine®), and chloroquine (Aralen®). Hydroxychloroquine is prescribed the most because it’s thought to cause the fewest side effects. In people who can’t tolerate hydroxychloroquine, chloroquine is given. Quinacrine is prescribed the least because it causes yellowing of the skin.
The most common side effects of antimalarials include:
- Dry skin or rashes
- Changes in skin pigmentation
- Upset stomach, bloating, and loss of appetite
- Damage to the retina in the eye
While taking antimalarials like hydroxychloroquine or chloroquine, there’s a slight risk of damaging the retinas in your eyes. Your doctor will likely recommend that you see an eye doctor at least once a year to check your eye health and ensure there’s no damage.
Immunosuppressives do just as their name suggests — they help suppress the immune system. These medications are used to treat a variety of diseases, including other autoimmune conditions such as rheumatoid arthritis (RA), and cancer. In fact, some immunosuppressives are also used as chemotherapies for cancer because they interfere with the DNA in dividing cells. In lupus, these therapies prevent immune cells from dividing and growing, which stops inflammation from occurring.5
Doctors often prescribe immunosuppressives to help manage more serious lupus symptoms that affect the brain, lungs, kidneys, and cardiovascular system. They can be given alone or alongside other lupus treatments, such as corticosteroids, to help control inflammation and prevent unwanted side effects. The three most commonly prescribed immunosuppressives for treating lupus are azathioprine (Imuran®), cyclosporine (Neoral®, Gengraf®, Sandimmune®), and mycophenolate mofetil (CellCept®, Myfortic ®).
Common side effects of immunosuppressants include:
- Stomach pain
- Decrease in blood cell counts
- Difficulties sleeping
- Swelling in the hands and feet
In some cases, cyclosporine may cause high blood pressure and the buildup of uric acid, a waste product made by the body from breaking down proteins. This buildup may lead to a joint condition known as gout.
Disease-Modifying Antirheumatic Drugs (DMARDs)
Since lupus can cause joint damage with long-term inflammation, some doctors prescribe disease-modifying antirheumatic drugs (DMARDs) to help reduce pain and swelling while also preventing joint damage. Typically, these medications are given to people with RA or other inflammatory diseases that attack the joints.5
Two DMARDs given to people with lupus include methotrexate (Rheumatrex®, Rasuvo ®, Otrexup ®) and leflunomide (Arava®). They work by stopping immune cells from replicating, preventing them from causing inflammation and attacking the joints. Symptoms of DMARDs include:
- Mouth sores
- Gradual hair loss
- Decrease in liver function
Voclosporin for Lupus Nephritis
In January 2021, the Food and Drug Administration (FDA) approved voclosporin (LupkynisTM) as the first oral treatment for lupus nephritis. Voclosporin is an immunosuppressant that binds to calcineurin, which is used by immune cells known as T cells for activation. Because the drug binds to the protein, it can’t be used to activate T cells, preventing inflammation from developing.6 The most commonly reported side effects from the clinical trials included:
- High blood pressure
- Low red blood cell count (anemia)
Monoclonal antibodies (mAbs) are man-made antibodies engineered to target a specific part of the immune system in order to dampen inflammation.7 Currently, there are two mAbs approved to treat systemic lupus erythematosus (SLE).
Belimumab (Benlysta®) is FDA-approved as an IV infusion or a subcutaneous (under the skin) injection for treating adults with active SLE or lupus nephritis. It is also approved as an IV infusion for treating children ages five and older with SLE.8 Anifrolumab-fnia (Saphnelo®) is FDA-approved for treating adults with moderate to severe SLE.9 Side effects of these therapies include:
- Increased risk of infections, such as bronchitis, upper respiratory infections, and shingles
- Difficulty sleeping
Managing Mental Health with Lupus
Living with an autoimmune disease like lupus can be stressful and tiring, especially during flares. Between 80 to 90 percent of people living with lupus have associated mental health symptoms such as headaches, depression, and difficulty remembering or thinking due to lupus (known as lupus fog). Major anxiety and depression are also common, affecting 37 percent and 25 percent of people with lupus, respectively.10
If you notice a change in your thoughts or mood, or if you have difficulty thinking and remembering, talk to your doctor. They can help you adjust your medication or add a new one—such as an antidepressant—into your regimen to help treat these conditions.10,11
The Future of Lupus Treatments
As researchers and doctors continue to learn more about lupus, new treatments will follow. There are several clinical trials currently investigating new therapies, in addition to already-existing drugs for other autoimmune diseases.
Learn more about new lupus treatments that are currently being developed and ongoing lupus clinical trials.