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Systemic lupus erythematosus - Treatment
- Highlights
- Introduction
- Causes
- Risk Factors
- Symptoms
- Complications
- Prognosis
- Diagnosis
- Treatment
- Treatment for Cutaneous and Mild SLE
- Treatment for Severe SLE
- Lifestyle Changes
Description
An in-depth report on the causes, diagnosis, treatment, and prevention of lupus.Alternative Names
Lupus
Treatment:
No treatment cures systemic lupus erythematosus, but many therapies can suppress symptoms and relieve discomfort. Treatment of SLE varies depending on the extent and severity of the disease.
Only three drugs are FDA-approved for the treatment of lupus:
- Prednisone
- Aspirin
- Hydroxychloroquine
However, none of these drugs are the current standard of care. In everyday practice, numerous other drugs are commonly used. Researchers are conducting numerous clinical studies and drug investigations. Genetic research in lupus is progressing very rapidly, and hopefully new drugs will be approved in the future. There are also different drugs available to treat some of the conditions associated with lupus.
Treating Mild Systemic Lupus Erythematosus
Less intensive treatments may be effective for symptoms of mild lupus. They include:
- Creams and sunblocks for rashes
- Nonsteroidal anti-inflammatory drugs for fever, arthritis, and headache
- Antimalarial drugs for pleurisy, mild kidney involvement, and inflammation of the tissue surrounding the heart
Treating Severe Systemic Lupus Erythematosus
More aggressive treatment is needed if there is serious disease progression, as evidenced by:
- Hemolytic anemia
- Low platelet count with an accompanying rash (thrombocytopenia purpura)
- Major involvement in the lungs or heart
- Significant kidney damage
- Acute inflammation of the small blood vessels in the extremities or gastrointestinal tract
- Severe central nervous system symptoms
The primary approach to treating severe SLE is to suppress the immune factors, most often first with corticosteroids and other immunosuppressant drugs. Investigational drugs and procedures are also showing promise.
Treating Specific Complications
The major complications of the disease must be treated as separate problems, keeping in mind the specific aspects of SLE. They are discussed elsewhere in this report.
Resources
- www.lupus.org -- Lupus Foundation of America
- www.lupusny.org -- SLE Lupus Foundation
- www.niams.nih.gov -- National Institute of Arthritis and Musculoskeletal and Skin Diseases
- www.rheumatology.org -- American College of Rheumatology
- www.lupusresearchinstitute.org -- Lupus Research Institute
References
Bernatsky S, Ramsey-Goldman R, Isenberg D, Rahman A, Dooley MA, Sibley J, et al. Hodgkin's lymphoma in systemic lupus erythematosus. Rheumatology (Oxford). 2007 May;46(5):830-2. Epub 2007 Jan 25.
Bertsias G, Ioannidis JP, Boletis J, Bombardieri S, Cervera R, Dostal C, et al. EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis. 2008 Feb;67(2):195-205. Epub 2007 May 15.
Crosbie D, Black C, McIntyre L, Royle PL, Thomas S. Dehydroepiandrosterone for systemic lupus erythematosus. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005114.
Crow MK. Collaboration, genetic associations, and lupus erythematosus. N Engl J Med. 2008 Feb 28;358(9):956-61. Epub 2008 Jan 20.
D'Cruz DP, Khamashta MA, Hughes GR. Systemic lupus erythematosus. Lancet. 2007 Feb 17;369(9561):587-96.
Gompel A, Piette JC. Systemic lupus erythematosus and hormone replacement therapy. Menopause Int. 2007 Jun;13(2):65-70.
Harel-Meir M, Sherer Y, Shoenfeld Y. Tobacco smoking and autoimmune rheumatic diseases. Nat Clin Pract Rheumatol. 2007 Dec;3(12):707-15.
Khamashta MA. Systemic lupus erythematosus and pregnancy. Best Pract Res Clin Rheumatol. 2006 Aug;20(4):685-94.
Klareskog L, Padyukov L, Alfredsson L. Smoking as a trigger for inflammatory rheumatic diseases. Curr Opin Rheumatol. 2007 Jan;19(1):49-54.
Kocis P. Prasterone. Am J Health Syst Pharm. 2006 Nov 15;63(22):2201-10. Lane NE. Therapy Insight: osteoporosis and osteonecrosis in systemic lupus erythematosus. Nat Clin Pract Rheumatol. 2006 Oct;2(10):562-9.
Mackillop LH, Germain SJ, Nelson-Piercy C. Systemic lupus erythematosus. BMJ. 2007 Nov 3;335(7626):933-6.
Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med. 2008 Feb 28;358(9):929-39.
Sabahi R, Anolik JH. B-cell-targeted therapy for systemic lupus erythematosus. Drugs. 2006;66(15):1933-48.
Salmon JE, Roman MJ. Subclinical atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus. Am J Med. 2008 Oct;121(10 Suppl 1):S3-8.
Sánchez-Guerrero J, González-Pérez M, Durand-Carbajal M, Lara-Reyes P, Jiménez-Santana L, Romero-Díaz J, et al. Menopause hormonal therapy in women with systemic lupus erythematosus. Arthritis Rheum. 2007 Sep;56(9):3070-9.
Walsh M, James M, Jayne D, Tonelli M, Manns BJ, Hemmelgarn BR. Mycophenolate mofetil for induction therapy of lupus nephritis: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2007 Sep;2(5):968-75. Epub 2007 Aug 8.
- Reviewed last on: 2/19/2009
- Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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