Systemic Lupus Erythematosus (SLE) affects nearly 1.5 Million Americans, but unless you’re diagnosed, chances are you don’t know much about it. In a nutshell, SLE is a chronic (long-term) autoimmune disease that causes the body’s immune system to become overactive and attack normal, healthy tissue. It can cause inflammation, swelling, and fatigue as well as damage to the joints, skin, kidneys, blood, heart, and lungs. Like many other chronic conditions, there are multiple treatment options, but whereas research is leading to new, effective medicines for many conditions, new treatments for lupus are still lacking. In fact, there has only been ONE new medication approved by the Food and Drug Administration for the treatment of Lupus in the last FIFTY years! Currently, there are five classes of medications available for treating lupus; let’s take a look. 

NSAIDS: These medications, including Avil, Motrin, Celebrex, and Mobic, are anti-inflammatory medications and may relieve some Lupus symptoms by reducing inflammation that causes stiffness or pain in your muscles and joints. NSAIDs are generally used to treat mild flares or in combination with other medications for more severe flares. Side effects can be but are not limited to stomach pain and heartburn, stomach ulcers, a tendency to bleed more, headaches and dizziness, ringing in the ears.

Anti-Malaria Drugs: Approved by the FDA in 1955, Plaquenil was the first and is still the most established lupus treatment, often offered immediately after diagnosis to relieve lupus symptoms such as fatigue, rashes, joint pain or mouth sores. Unless a patient develops adverse side effects, most will will continue to take it indefinitely. Of course, some patients describe benefiting more than others.  Side effects may include headache, dizziness, ringing in your ears, nausea, vomiting, stomach pain, loss of appetite, weight loss, mood changes, feeling nervous or irritable, skin rash or itching, or hair loss.

Steroids: Synthetic cortisone medications like prednisone, prednisolone and Medrol can also be effective against lupus. A bit like NSAIDs, steroids can reduce the swelling, warmth, pain, and tenderness associated with the inflammation of lupus, and often work quickly. However, steroids may also provoke more aggressive side effects than NSAIDs, including weight gain, insomnia, mood swings, and hot flashes. Steroids are generally only prescribed when other meds, like NSAIDs and Plaquenil are not controlling the disease. Unless absolutely necessary, long term use of steroids is not recommended. 

Immunosuppressive Medications: If lupus can be thought of as the result of an overactive immune system, then immunosuppressive medications are one way to tamp down its effects. Many of the medications in this class were originally used in patients receiving organ transplants to help prevent the immune system from attacking transplant tissue and leading to organ failure. Following are a few of the most common:

• Imuran: After being developed as an anti-rejection medication for use with organ transplant, Imuran was approved in the 1980s for use in arthritis. Unfortunately, the drug can also reduce white and red blood cell counts, and so use requires frequent lab draws. Side effects may include upset stomach, nausea, vomiting, diarrhea, loss of appetite, hair loss, skin rash.
• Cellcept: Used especially in Lupus patients who have kidney disease, Cellcept works by targeting a specific enzyme responsible for chemical reactions important in the formation of DNA in your cells, thus impairing immune system function. It takes 6-12 weeks to start seeing results. The FDA approved Cellcept for use in Lupus patients in the 1980s. Side effects may include constipation, nausea, headache,
  diarrhea, vomiting, stomach pain or upset, loss of appetite, gas.
• Methotrexate: A chemotherapy agent that acts as an immunosuppressant and is in a category called disease-modifying antirheumatic drugs (DMARDs). Mtx is the Gold Standard for treating Rheumatoid Arthritis (RA), and is used to treat pain and swelling in lupus patients who have developed arthritis. DMARDs not only reduce this pain and swelling, but they may also be able to decrease long term damage to joints. Side effects may include fever, chills, tiredness, not feeling well, mouth sores, nausea, upset stomach, dizziness, or abnormal liver function tests
• Cytoxan: An aggressive immunotherapy used in patients with severe lupus to improve the outcome for those with major organ disease, especially those with kidney involvement. Side effects may include thin, brittle hair, darkened and thickened skin, blistering skin or acne, loss of appetite or weight, fatigue, cough, congestion, fever.

Monoclonal Antibodies

In 2011, Benlysta was the first new medicine to be approved for the treatment of lupus in 50 years! In fact, it was a totally new way of thinking for the treatment of Lupus. Benlysta is a monoclonal antibody — a biological medication that works by calming down the hyperactive immune systems of lupus patients by inhibiting a protein called B lymphocyte stimulator (BLyS), which is believed to increase inflammatory reactions that attack and damage the body’s healthy tissues. Basically, the medication selectively quiets the immune system against things like joints, the heart, and the brain. When it was first approved by the FDA in 2011, it was only available for adults, and only available to be given intravenously. In 2018 the FDA approved an injectible form of the drug, and in April 2019 it was approved for treatment of lupus in everyone over the age of five. Side effects may include nausea, vomiting, diarrhea, stomach pain, pain in your arms or legs, trouble sleeping (insomnia), headache (migraine), fever.

Unfortunately, the fact remains that there is no perfect treatment for lupus — to put it another way, in a disease named after a wolf, there is no “silver bullet.” Many treatments work for some patients but not others, or reduce but don’t eradicate symptoms, or come with unsustainable side effects. The good news is that U.S.F.D.A. and other government funding agencies have ramped up their commitment to lupus research, leading to the development of several drugs currently being tested in clinical trials. And maybe, just maybe, this research will mean that this article is quickly out of date. Maybe now is the time for new, effective treatments against lupus.

Amber Blackburn

Amber graduated with her Associates of Science in Nursing in 2007 and her Bachelors Degree in Nursing in 2011. In July 2012 she was finally diagnosed with Systemic Lupus. Since that time she has also been diagnosed with Fibromyalgia, Endometriosis, Interstitial Cystitis and Debilitating Migraines. She feels very fulfilled in the work she is currently doing and can’t wait to see what will happen in the future. Find more of her writing at TheWorldSeesNormal.com