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Lupus treatments fall into two main categories: disease-modifying medications and medications for managing lupus symptoms. Because lupus can cause such a wide variety of symptoms, many different classes of drugs are used to treat it. A few drugs are specifically approved by the U.S. Food and Drug Administration (FDA) for lupus, but several medications approved for other conditions are commonly prescribed off-label to treat lupus.
Guidelines for lupus treatment plans are based on the severity of the disease, which organs or tissues are involved, a person’s age and overall health, and any other health conditions or medications being taken.
Among the broad categories of treatments for lupus are nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs).
NSAIDs can ease fever and mild pain and inflammation. Some NSAIDs such as aspirin, ibuprofen (Motrin), and naproxen are available over the counter, while celecoxib (Celebrex) and indomethacin (Indocin) require a prescription. NSAIDs are believed to work by inhibiting the production of chemicals that promote inflammation and blood clot formation in the body. Taken regularly at high doses, some NSAIDs can cause gastrointestinal problems, kidney problems, and abnormal bleeding.
In lupus, the body’s immune system attacks tissues and organs, causing inflammation, damage, and symptoms. DMARDs suppress elements of the immune system involved in these autoimmune attacks. Some disease-modifying lupus medications are considered maintenance treatments, taken long term to help prevent lupus flares and slow the progression of lupus damage. Some DMARDs may be taken only during disease flare-ups.
There are several types of disease-modifying medications for lupus. Antimalarial drugs, which include hydroxychloroquine (Plaquenil) and chloroquine (Aralen), are among the oldest classes of drugs used to treat lupus, and they are still used widely today. Antimalarials are taken orally (by mouth).
Cyclophosphamide (Cytoxan) is a chemotherapy drug for cancer. It is given orally or through a vein (intravenously). Cyclophosphamide is most likely to be prescribed in cases of severe lung or kidney involvement. Immunosuppressants prescribed for lupus include azathioprine (Imuran), methotrexate, and mycophenolic acid (Myfortic).
Biologics are a newer class of drugs available for treating lupus. Biologics are genetically engineered antibodies, or proteins used by the immune system to identify and neutralize substances. Belimumab (Benlysta) was approved in 2011 by the FDA, making it the first new drug approved to treat lupus in more than 50 years. Benlysta can be self-injected at home or given as an intravenous (IV) infusion. In 2021, anifrolumab-fnia (Saphnelo), another biologic, was approved to treat lupus. This drug is given as an infusion in a hospital or clinic. Rituximab (Rituxan), a biologic used off-label to treat lupus, is also given as an IV infusion.
Because DMARDs suppress aspects of the immune system, many of these lupus treatments can increase your risk of contracting infections. Each DMARD has specific side effects and particular levels of risk. Your doctor can help you understand the risks and benefits of each lupus medication based on your medical history and individual condition.
| Lupus nephritis treatments: medication and diets to support kidney health |
Corticosteroids such as prednisone, dexamethasone, methylprednisolone, and repository corticotropin injection (Acthar Gel), a closely related drug, can help suppress disease activity during acute flares or in cases of severe kidney or central nervous system (CNS — brain and spine) involvement. Corticosteroids, also called steroids, are powerful medications that suppress immune activity and relieve inflammation. Corticosteroids may be administered intravenously or taken orally. In cases of lupus rash, topical corticosteroid creams may also be prescribed.
Taken for short periods, corticosteroids are safe and effective. However, if used long term, corticosteroids can cause serious side effects including osteoporosis, cataracts, and serious metabolic disorders such as diabetes and Cushing’s syndrome.
Lupus can cause a wide array of symptoms. Some lupus symptoms can become severe enough to be life-threatening, while others can cause disability or lowered quality of life. Symptom management medications can help manage some lupus symptoms, but unlike DMARDs, they do not treat the underlying disease.
About half of those with lupus have proteins called antiphospholipid antibodies (also called lupus anticoagulants) in their blood that promote the formation of dangerous blood clots inside the blood vessels (thromboses). Many people with lupus take anticoagulants (blood thinners) such as warfarin (Coumadin) and heparin (Liquaemin) to help prevent thromboses. Aspirin is also taken as a blood thinner.
According to the Johns Hopkins Lupus Center, anywhere from 25 percent to 50 percent of people with lupus have high blood pressure caused by the disease or side effects of medications. High blood pressure silently damages organs and raises the risk of stroke and heart attack. Many people with lupus take antihypertensive drugs, of which there are a number of classes.
Examples of antihypertensive drugs include:
Antidepressants such as citalopram (Celexa), duloxetine (Cymbalta), fluoxetine (Prozac), and sertraline (Zoloft) can address depression in people with lupus. Certain antidepressants have been shown to relieve fatigue or neuropathic pain.
When lupus affects the CNS, it can cause seizures. Some people with CNS lupus take anticonvulsive medication such as pregabalin (Lyrica) or gabapentin (Neurontin).
If NSAIDs fail to relieve pain caused by lupus, opioids such as codeine, tramadol (Ultram), and oxycodone/acetaminophen (Percocet) may be needed. Opioids are believed to work on the brain by altering the body’s ability to perceive pain. According to the National Institute on Drug Abuse, regular use of opioids — even as prescribed by a doctor — can lead to dependence. If misused, opioids can cause overdose and death.
Some people with lupus prefer to try natural treatments and report relief from certain symptoms when they use complementary or alternative treatments such as medical cannabis, dietary supplements, or acupuncture.
Currently, there is no cure for lupus. The good news is that although lupus is not currently curable, the prognosis for people with lupus is better than ever. Before modern treatments for lupus, less than 50 percent of people lived for five years after being diagnosed. Now the five-year survival rate is 95 percent, according to the Lupus Foundation, and the majority of people with lupus live a normal average life span.
Like everyone else, people with lupus feel their best when they consistently eat a healthy, balanced diet. Most physicians who specialize in lupus recommend the same low-fat, high-fiber diet recommended by the American Cancer Society and American Heart Association. A balanced, nutritious diet can also help you maintain a healthy weight and lower your risk of developing dangerous chronic conditions such as diabetes, osteoporosis, and heart disease.
Some people with lupus feel better when they follow popular anti-inflammatory diets, but no clinical studies have been done to prove the benefit of this approach.
Certain foods have been shown to make lupus symptoms worse. These include garlic, which may strengthen the immune system, and alfalfa sprouts, which contain a protein that may promote inflammation. Drinking alcohol can make some medications less effective and interact dangerously with other drugs (including NSAIDs). Those with high blood pressure should minimize their salt intake to avoid serious complications.
Some people with lupus may benefit from dietary supplements if they are low on certain nutrients. For instance, doctors may recommend that those with osteoporosis increase their intake of calcium and vitamin D.
People with lupus nephritis may need to follow a more specific diet plan to protect their kidney health.
Learn more about diet and nutrition for lupus, including foods to eat and avoid.
On MyLupusTeam, the social network for people with lupus and their loved ones, more than 215,000 members come together to ask questions, give advice, and share their stories with others who can relate to their lupus experience.
Are you or a loved one living with lupus? Do you have questions about treatments used for lupus? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.
