Medications Used to Treat Lupus

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are often used to reduce pain and inflammation in patients who have mild systemic lupus erythematosus (SLE). Many different types of NSAIDs exist, some of which you can buy without a doctor’s prescription. These are called “over-the-counter” drugs. Examples of over-the-counter NSAIDs include aspirin, Motrin,¹ Orudis, and Anaprox. Tylenol is not an NSAID and is not used to reduce the inflammation of lupus.

Although all NSAIDs appear to work in the same way, there are differences among them. Not every NSAID has the same effect on every person. Also, you may find that one NSAID works well for a while, then for some unknown reason, it doesn’t work well any more. Your doctor will probably switch you to a different NSAID to get the same helpful effects you had with the first one.

Antimalarials

Antimalarials are very effective in controlling lupus arthritis, skin rashes, mouth ulcers, and other symptoms such as fatigue and fever. They are used to manage less serious forms of systemic lupus erythematosus (SLE) in which no organs have been damaged. Antimalarials are also very effective in the treatment of discoid lupus erythematosus (DLE).

Although antimalarials may be very effective in controlling your lupus, their use takes patience. It may take weeks or months before you see any change in symptoms from the use of these drugs.

Corticosteroids

Corticosteroids are very powerful drugs that reduce inflammation in various tissues of the body. These drugs are used to treat many of the symptoms of lupus that result from inflammation. You can take this medication as pills or by injection. Corticosteroid creams or ointments are also available to treat skin rashes caused by lupus. Most lupus symptoms respond quickly to corticosteroids. Prednisone is a corticosteroid that is often used to treat lupus.

The decision to begin corticosteroids is a big one and depends on your needs. Some patients may need to take the drug for a short time only, until disease symptoms get better or go away. Others with more serious or life-threatening problems may require higher doses of the drug for longer periods of time. In general, once your lupus symptoms have responded to treatment, you will gradually take less and less of the drug until you can stop completely. If it is not possible for you to stop the drug completely, your doctor will give you the smallest amount possible to keep symptoms under control.

Doctors are careful about prescribing corticosteroids because many complications are associated with taking this drug. As a result, it is important to take the drug exactly as prescribed. People who have been taking corticosteroids for a long time may need higher doses of the drug before, during, or after a physically stressful event, such as surgery.

Azathioprine

Azathioprine is a drug that acts to suppress the work of the immune system. It is used mainly in organ transplantation to prevent the body from rejecting the new organ. The drug is also used in patients with lupus who have damage to their kidneys or other organs, muscle inflammation, or advanced arthritis. Azathioprine helps to reduce symptoms and damage to the affected organs. It can also help achieve a remission of the disease.

Another benefit of azathioprine is that it reduces or even eliminates the need for corticosteroid therapy. This means that patients do not have to have the unpleasant side effects that occur with corticosteroids. Immunosuppressives like azathioprine, however, can have their own serious side effects. Your doctor must work closely with you to make sure that the amount of the drug you are taking gives you the benefits you need with as few side effects as possible.

Cyclophosphamide

Cyclophosphamide is a drug used to treat a number of cancers, and it is used to treat patients with lupus when major organs, such as the kidneys, are affected. It is also used to treat severe inflammation that has not responded to corticosteroids. In lupus, the immune system is too active. Cyclophosphamide slows down the immune system so that disease activity can be reduced.

Cyclophosphamide is a very powerful drug. It can have a number of effects on the body. As a result, it is important that you understand how it is used to treat your lupus. You will need to work closely with your doctor and nurse to make sure that the amount of the drug you are taking gives you the benefits you need with as few side effects as possible.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, January 1999