Medication for Lupus in Children
There is no cure for lupus, but early diagnosis and treatment with medication increase a child’s chance of becoming symptom free, or achieving remission. The longer your child’s lupus is in remission, the less likely he or she is to develop complications, such as kidney damage.
Doctors at Hassenfeld Children’s Hospital at NYU Langone may use one or more medications to treat symptoms such as joint pain and to reduce inflammation and its impact on organs.
Nonsteroidal Anti-inflammatory Drugs
A nonsteroidal anti-inflammatory drug (NSAID) can be used to relieve minor joint pain in children with lupus. An NSAID that works for one child may not work for another.
Some NSAIDs, such as ibuprofen and naproxen, are available without a prescription. Others, such as indomethacin and celecoxib, are available only by prescription. Your child can take these medications by mouth or in pill or liquid form.
Children usually tolerate NSAIDs well, but the drugs may cause gastrointestinal side effects, such as abdominal pain, when taken in high doses. Your child’s doctor can advise you on the dosage needed to avoid these effects.
Your child’s doctor may prescribe an antimalarial medication, such as hydroxychloroquine. Although these medications are typically used to prevent and treat malaria, a mosquito-borne infection, they are also used to prevent and treat the symptoms of lupus, such as rash and joint pain. Antimalarial medications help suppress the immune system without increasing the risk of serious infection.
Antimalarial medications are given once a day by mouth in a pill that can be crushed and added to soft foods, such as applesauce. Rarely, complications involving the eye may occur after this medication has been taken for many years.
Doctors may use immunosuppressant medications to dampen an overactive immune system and prevent further organ damage in children with severe lupus. Treatment with these medications can continue for months or longer, depending on the severity of a child’s symptoms.
Some immunosuppressants, such as methotrexate, azathioprine, and mycophenolate mofetil, can be taken by mouth, in pill or liquid form, or as an injection. It may take several weeks or longer for this medication to take effect. Our doctors may treat symptoms of inflammation, such as pain and swelling, with NSAIDs until an immunosuppressant begins to relieve symptoms.
Other immunosuppressants, such as cyclophosphamide, may be given through a vein as an intravenous (IV) infusion. This medication is typically given once a month for six months, then every three months for two years.
Immunosuppressants prevent bone marrow from making the white blood cells that mistakenly attack healthy tissues. But suppressing those cells also suppresses the immune response, weakening the body’s ability to fight infection. Nausea is another common side effect.
Medications called corticosteroids, or simply steroids, suppress the immune system. Creams that contain low doses of steroids may be used to treat lupus-related rashes. Doctors may use higher doses of steroids, given by mouth or through a vein as an IV infusion, to treat more severe symptoms.
Children with severe symptoms may need to take steroids every day; those with milder symptoms may need them less often.
Keep in mind that taking corticosteroids by mouth or via IV infusion for long periods of time can lead to bone loss. These medications can also cause weight gain, acne, and moodiness, and can reduce the production of hormones needed to regulate salt and fluid levels in the body.
Targeted Biologic Therapies
Targeted therapies, also called biologics, include newer medications, such as belimumab, that help reduce inflammation. These medications block the activity of cytokines—immune system cells that cause inflammation.
Rituximab is another biologic therapy that targets specific immune cells in the body associated with lupus.
Doctors give targeted therapies as an IV infusion every few weeks. The drugs may cause mild gastrointestinal side effects, such as nausea and diarrhea, and carry a risk of serious infection.
The doctor may prescribe anticoagulants, or blood thinners, in children who have developed a blood clot due to antiphospholipid syndrome. This condition increases the risk of recurrent blood clots, and so your child may need to take blood thinners for life.
One type of anticoagulant, warfarin (Coumadin®), is given daily by mouth. Another anticoagulant, low molecular-weight heparin, is given by injection and may be used if your child needs any type of surgical procedure.
Monitoring for Side Effects
Children with lupus receiving any of these medications come to Hassenfeld Children's Hospital once a month for monitoring of side effects and adjusting medication dosages, as needed. During a follow-up visit, the doctor repeats urine and blood tests and takes your child’s blood pressure to look for signs of kidney problems.
The doctor may also recommend calcium and vitamin D supplements to prevent bone loss and can make referrals to other specialists if your child develops kidney damage, seizure disorders, or other serious complications.