In general, it can safely be said that mild disease activity requires nothing more than mild treatment, whereas severe disease manifestations require aggressive therapeutic interventions. However, it must be emphasized that all medicines can cause side effects and that it is crucial for the doctor to weigh the potential benefits and risks of specific medicines. As a rule of thumb, mild medicines have mild side effects, and more aggressive therapies are associated with more serious side effects. Be informed! Your doctor is just one source of information about medicines. Other sources include the Lupus Alliance, your pharmacist, the package insert, the Physician Desk Reference (PDR) or the Merck Manual, Internet websites, and of course the myriad of books written about lupus. Your local lupus agency can point you in the proper direction!

For minor joint and muscle pains, nonsteroidal anti-inflammatory drugs-NSAID’s (ibuprofen; naproxen) or acetaminophen (Tylenol®) may be sufficient. For mild rash, creams and ointments may suffice, whereas severe rashes or other significant symptoms may require corticosteroids (prednisone) or antimalarial drugs (hydroxychloroquine: Plaquenil®). Those patients with very active disease that may be compromising organ function (e.g. lupus kidney disease) will require corticosteroids and/or immunosuppressive agents (azathioprine: Imuran®; cyclophosphamide: Cytoxan®). Anticoagulants (warfarin: Coumadin®) are often used for those patients who have shown a tendency toward developing blood clots. In certain situations, doctors will use drugs (methotrexate; mycophenolate: CellCept®; leflunomide: Arava®; thalidomide) that have been useful in patients with other autoimmune diseases that resemble lupus. In addition, some drugs are used to counteract the adverse effects of drugs used to control disease activity. Common examples include the use of drugs to prevent osteoporosis in patients on corticosteroids or stomach protective agents for those patients on NSAID’s. Over the last 10 years there has been unprecedented activity in the field of drug development for autoimmune diseases. Although a new drug has yet to be approved for lupus, several drugs are in development and hold future promise to provide safer and more effective treatments for lupus patients.

In summary, there are many different types of medicines used to treat lupus. Which ones are used depend on the specific manifestations in need of treatment as well as the activity and severity of the patient’s disease. Most physicians will make a list of all of the patient’s manifestations in order of most severe to least severe. Then, the physician should choose the least aggressive drug and lowest dose of drug that will control the most serious of all of the disease manifestations. Generally, the less severe disease manifestations will come under control as the more serious ones respond. Don’t be afraid to ask questions. Understand what your doctor wants to accomplish with treatment and understand what the medicines might do for you and to you.
- Information provided by Dr. Richard Furie, North Shore University Hospital