Medications for Systemic Lupus Erythematosus

At NYU Langone, treatment for systemic lupus erythematosus, commonly known as lupus, depends on your symptoms. Most people with lupus take more than one kind of medication to control symptoms such as rashes, inflammation, pain, fatigue, and swelling, and to keep lupus from causing damage to the joints, kidneys, heart, blood vessels, and other systems in the body.

Because lupus is a chronic condition that goes through periods of flare-ups and remission, your treatment may vary over time. Your NYU Langone rheumatologist sees you regularly in order to monitor your symptoms and adjust treatment when necessary. 

Analgesics

Your doctor may suggest over-the-counter medications designed to reduce pain and inflammation and treat fever associated with lupus. These may include acetaminophen or aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. NSAIDs may produce side effects that worsen some lupus conditions, such as kidney disease, and so your doctor can advise you on how best to use these medications to treat your symptoms.

Corticosteroids

For people with lupus, inflammation is the result of an autoimmune response, in which the immune system attacks the body’s healthy tissues. If you are experiencing joint pain, skin rashes, or other effects of inflammation, your NYU Langone doctor may prescribe a corticosteroid, which suppresses inflammation.

Doctors may prescribe high-dose corticosteroids to treat severe or life-threatening lupus-related symptoms and conditions, including kidney disease; brain disease, such as life-threatening seizures; inflammation of the blood vessels, or vasculitis; nerve damage; pericarditis, an inflammation of the sac that covers the heart; and pleuritis, inflammation of the lungs. Corticosteroids may also be used to treat anemia, which is a low number of red blood cells.

People with lupus may need corticosteroids for weeks at a time. They can be taken by mouth, by injection, or through a vein with intravenous (IV) infusion in the doctor’s office. Some corticosteroids are applied to the skin as a cream to ease the itching, redness, and pain associated with lupus-related rashes. 

Corticosteroids can cause side effects including acne, irritability, trouble sleeping, weight gain, and a loss of bone density. Your doctor weighs your individual symptoms and overall health before deciding whether these medications are right for you.

Antimalarial Medications

When lupus affects the kidneys, brain and nervous system, skin, or joints, doctors may prescribe medications that control an overactive immune system. People can take these medications by mouth or a weekly or monthly injection. Immunosuppressive medications increase the risk for infection; call your doctor if you notice any signs of infection while on these medications. 

Immunosuppressive Medications

When lupus affects the kidneys, brain and nervous system, skin, or joints, doctors may prescribe medications that control an overactive immune system. People can take these medications by mouth or a weekly or monthly injection. Immunosuppressive medications increase the risk for infection; call your doctor if you notice any signs of infection while on these medications.

Anticoagulants

Because lupus can sometimes cause serious blood clotting, doctors may prescribe anticoagulants. These medications block the production of proteins in the liver that cause blood to clot. While taking anticoagulants, it’s important to avoid smoking, which can lead to blood clots, or drinking alcohol, which can interfere with the medication. 

B-cell Biologic Medications

Sometimes doctors prescribe cancer medications for people with lupus. These medications reduce the activity of B cells, a type of white blood cell that can create autoantibodies that attack healthy tissues, the cause of lupus. These medications can help treat people with very low levels of platelets, a blood cell that helps with clotting. They can also treat lupus nephritis, an inflammation of the kidneys, and vasculitis, an inflammation of the blood vessels associated with lupus.

NYU Langone doctors may prescribe a recently approved B-cell biologic medication called belimumab, or Benlysta®. Given intravenously, it may help some people with mild-to-moderate lupus whose flare-ups don’t respond well to antimalarial medications. This medication may also reduce the need for ongoing use of high-doses of corticosteroids.

Because biologic medications control the immune system by suppressing white blood cells, some people are at a higher risk for cancer. Your doctor carefully weighs your individual health factors before deciding whether to recommend them and monitors you regularly throughout treatment. 

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