Lupus Treatment Options

There are several lupus treatment options. However, there is no “best" treatment for lupus because each person living with the condition will have their own needs and goals for managing it.

Lupus treatment may include medications such as immunosuppressives, antimalarials, steroids, and biologics. It can also include alternative therapies and lifestyle changes. The right treatment depends on what will be the safest and most effective for that individual. 

This article will cover lupus treatment options, including the most common treatments for lupus and what to know about safety for each. 

Types of Lupus
Verywell / Emily Roberts

Goals of Lupus Treatment

Lupus treatment options are tailored to your needs and may change over time. It’s important that you take an active role in managing lupus, which includes reevaluating your treatment plan with your provider regularly to make sure it’s working for you.

Your treatment plan for lupus will be based on your age, sex, overall health, symptoms, and lifestyle. Your provider will set several lupus management goals for you, including:

  • Reducing inflammation caused by the disease. Some treatments for lupus are specifically directed at lowering how much inflammation is in your body.
  • Suppressing your immune system. Overactive immune system responses contribute to high levels of inflammation. Certain lupus treatment options are geared toward dampening your immune system’s response. 
  • Prevent flares and treat them when they do occur. Medication and lifestyle changes can help you avoid lupus flares and manage your symptoms when they do happen. 
  • Control your symptoms. A combination of medications and lifestyle changes can help you cope with your ongoing lupus symptoms, as well as those that happen when you’re in a flare. 
  • Minimize complications. Avoiding the potentially major health complications of lupus will be an important long-term goal of your treatment. 

The treatments that your provider will recommend will also depend on the severity of the disease:

  • If you have mild lupus symptoms, you will likely be treated with an antimalarial and possible NSAIDs and/or a short-term dose of corticosteroids.
  • If you have moderate lupus symptoms, your treatment plan will likely include an antimalarial along with a short-term corticosteroid until the antimalarial has a chance to work. You may also benefit from an immunosuppressive drug. 
  • For severe lupus symptoms that involve your organs, you'll likely need an intense dose of immunosuppressive therapy. You may also need to take high doses of corticosteroids for a brief time to reduce inflammation. As with mild and moderate lupus, you will likely also benefit from an antimalarial.

The safety and effectiveness of treatments for lupus have improved in recent years, giving healthcare providers more choices about how they can help patients manage the disease.

Prescriptions

Prescription medications are an important part of the management of many patients with systemic lupus erythematosus (SLE), the main type of lupus. 

The medications that are most frequently used to control lupus symptoms are:

Lupus treatment should include as few medications as possible taken for as short a time as possible. Some patients never need medications, while others take them only as needed or for a short time. Other patients with lupus need constant drug therapy with different doses. 

Talk to your provider about why you need to be on a drug, how it works, how much you're supposed to take, when you need to take it, and what the potential side effects are.

Can Over-The-Counter (OTC) Meds Help Lupus?

NSAIDs and other over-the-counter (OTC) medications that reduce inflammation and help with pain might be part of your treatment plan. However, it’s important that you ask your provider before starting any OTC product or supplement, especially if you are taking prescription medications for lupus.

All lupus medications have risks. Most patients do well on lupus medications and have few if any side effects. If you do have side effects, tell your provider. 

You should never suddenly stop taking your lupus medications because doing so can be dangerous. Always ask your provider before changing your dose or stopping your treatment.

Lupus Doctor Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Antimalarials

Antimalarials are used to treat lupus-related conditions and symptoms like:

  • Lupus arthritis
  • Skin rashes
  • Mouth ulcers
  • Fatigue
  • Fever
  • Lung inflammation

Antimalarials are approved by the U.S. Food and Drug Administration (FDA) to treat lupus. They are also used to help prevent flares when they're taken continuously; however, they’re not used to manage more serious, systemic forms of lupus that affect the organs.

Types of antimalarials include:

  • Plaquenil (hydroxychloroquine sulfate)
  • Aralen (chloroquine)

It might take weeks or even months before you notice that these drugs are helping control your lupus symptoms.

Side Effects and Risks

Chloroquine is still used today but hydroxychloroquine sulfate is usually preferred because research suggests that it is a safer option. The anti-inflammatory action of these drugs is not well understood. Antimalarials also affect your platelets to reduce the risk of blood clots and lower plasma lipid levels.

A common side effect of antimalarials is stomach upset, but there are also some more serious adverse effects. For example, taking antimalarials has been linked to a chronic skin condition called psoriasis which has symptoms similar to subacute and discoid cutaneous lupus

You should also know that there are risks to taking medications like isotretinoin and thalidomide if you are pregnant. These drugs are teratogens, which means that they can damage a fetus. You should not take these drugs if you are thinking about getting pregnant or are pregnant.

Corticosteroids

Corticosteroids are strong anti-inflammatory drugs. They are highly effective at reducing inflammation, relieving muscle and joint pain and fatigue, and suppressing the immune system.  They are also useful in controlling the involvement of major organs in lupus.

Corticosteroids are approved by the FDA for treating lupus and are usually administered by mouth (orally).

Corticosteroids used to treat lupus include:

  • Prednisone (Sterapred)
  • Hydrocortisone (Cortef, Hydrocortone)
  • Methylprednisolone (Medrol)
  • Dexamethasone (Decadron)

Corticosteroids are available as:

  • Topical creams or ointments (for skin rashes)
  • Oral tablets
  • Liquid solutions
  • Steroid shots (intramuscular or intravenous injections)

Lupus patients with symptoms that do not get better or who are not expected to respond to other drugs might need to take a corticosteroid. 

Once your symptoms have started getting better, your dose will usually be tapered to the lowest possible dose that helps. Your provider will monitor you for any of your lupus symptoms coming back, which can happen when you lower your dose.

Some lupus patients only need corticosteroids during the active stages of the disease. Patients with severe disease or serious organ involvement may need long-term treatment. 

Healthcare providers sometimes give very large amounts of corticosteroid by IV over a brief time (usually days). This is called bolus therapy or pulse therapy. After getting the dose through an IV, you will usually go back to taking the drug by mouth, if needed.

If you've been on prolonged corticosteroid therapy, know that the drugs must not be stopped suddenly. Talk to your provider about slowly reducing and stopping your dose when it's time.

Side Effects and Risks

When you take corticosteroids, your body’s own production of adrenal hormones slows or stops. If you suddenly stop taking the drug, it can lead to adrenal insufficiency or even a life-threatening adrenal crisis.

Tapering the dose allows your body’s adrenal glands to recover and start making natural hormones on their own again. The longer you've been on corticosteroids, the harder it will be to lower your dose and stop taking them

Short-term side effects of corticosteroids include:

  • Increased pressure in the eyes (glaucoma)
  • Swelling
  • High blood pressure (hypertension)
  • Increased appetite
  • Weight gain

Long-term side effects of corticosteroids include:

  • Cataracts
  • High blood sugar (hyperglycemia) and diabetes
  • Infections
  • Weakened or damaged bones (osteoporosis and osteonecrosis)
  • Longer time for wounds to heal
  • Thinner skin that's easily bruised
  • Stretch marks

Typically, the higher the dose and the longer they are taken, the higher the risk and severity of side effects.

Prednisone for Lupus

Prednisone is the typical corticosteroid that providers prescribe to treat lupus—either alone or with other medications. However, it’s usually used as a short-term treatment. Prednisone is effective in treating active lupus and symptoms often get better quickly. People with mild cases of active lupus may never need to take it.

Side Effects of Prednisone

Contact your provider if you have any of the following common symptoms that either do not go away or are severe while you are taking prednisone:

  • Headaches
  • Dizziness
  • Difficulty falling asleep or staying asleep
  • Inappropriate happiness
  • Extreme changes in mood
  • Changes in personality
  • Bulging eyes
  • Acne
  • Thin, fragile skin
  • Red or purple blotches or lines under the skin
  • Slowed healing of cuts and bruises
  • Increased hair growth
  • Changes in the way fat is spread around the body
  • Extreme tiredness
  • Weak muscles
  • Irregular or absent menstrual periods
  • Decreased sexual desire
  • Heartburn
  • Increased sweating

Contact your provider immediately if you have any of the following serious symptoms while taking prednisone:

  • Vision problems
  • Eye pain, redness, or tearing
  • Sore throat, fever, chills, cough, or other signs of infection
  • Seizures
  • Depression
  • Loss of contact with reality
  • Confusion
  • Muscle twitching or tightening
  • Shaking of the hands that you cannot control
  • Numbness, burning, or tingling in the face, arms, legs, feet, or hands
  • Upset stomach
  • Vomiting
  • Lightheadedness
  • Irregular heartbeat
  • Sudden weight gain
  • Swelling or pain in the stomach
  • Difficulty breathing
  • Rash
  • Hives
  • Itching

Immunosuppressives / DMARDs (Disease-Modifying Anti-Rheumatic Drugs)

Immunosuppressives and other disease-modifying anti-rheumatic drugs (DMARDs) are used "off-label." This means they have not been approved by the FDA for treating lupus.

Immunosuppressives are used for serious, systemic cases of lupus where major organs such as the kidneys are affected, or when there is severe muscle inflammation or intractable arthritis. 

Immunosuppressives can also be used to reduce or even eliminate the need for corticosteroids.

Is Chemo Used to Treat Lupus?

Some chemotherapy drugs that are commonly used to treat cancer patients can help people with lupus because of how they work on the immune system. However, being treated with chemo if you have lupus does not mean you have cancer.

These drugs are the second line of defense against lupus and other forms of arthritis. They can be taken by mouth or given in an IV. Although they work in different ways, each type can help decrease or prevent an immune response.

Immunosuppressives and DMARDs used to treat lupus include:

  • Mycophenolate mofetil (CellCept). This medication is often used for lupus nephritis or treatment-resistant systemic lupus erythematosus (the main form of lupus). It can also help reduce the dosage of steroids you might need.
  • Azathioprine (Imuran, Azasan). Azathioprine inhibits gene replication and T-cell activation. Based on mouse/rat and some human studies, azathioprine is considered a weak immunosuppressive agent. However, it's cheaper than other immunosuppressives and can be used instead of steroids. Azathioprine works well after initiation of treatment with cyclophosphamide or mycophenolate.
  • Methotrexate (Rheumatrex). This drug is commonly used to treat autoimmune conditions like rheumatoid arthritis but is also a common way to treat lupus inflammation. 
  • Calcineurin inhibitors. These drugs stop T-cell activation and may help protect the kidneys of people with lupus nephritis.

Side Effects and Risks

Immunosuppressives and DMARDs can have serious side effects. The side effects that you have and the severity of them will depend on the dose and will usually get better or go away if you are able to stop taking the medication.

There are many serious risks associated with the use of immunosuppressives and DMARDs. These include:

  • Immunosuppression
  • Increased susceptibility to infection
  • Bone marrow suppression
  • Development of malignancies

Side effects of these medications may include:

  • Nausea
  • Vomiting
  • Hair loss
  • Bladder problems
  • Decreased fertility
  • Increased risk of cancer and infection

The risk for side effects increases with the length of treatment. As with other treatments for lupus, there is a risk of relapse after the immunosuppressives have been stopped.

Biologics

Benlysta (belimumab) is another FDA-approved drug for the treatment of active, autoantibody-positive lupus in patients who are receiving standard therapy including corticosteroids, antimalarials, immunosuppressives, and NSAIDs (nonsteroidal anti-inflammatory drugs).

Here are a few examples of biologics for lupus:

  • Benlysta is administered as an intravenous infusion and is the first drug to target B-lymphocyte stimulator (BLyS) protein, which should decrease the number of abnormal B cells—a problem in lupus.
  • Saphnelo (anifrolumab) has been approved in the United States for the treatment of adults with moderate to severe SLE who are receiving standard therapy. It is given as an intravenous infusion (into your vein using a needle or tube). Lupus involves the overactivation of interferons, which are signaling proteins. When interferons are out of balance and too many signals are generated, inflammation can occur in different parts of the body, causing illness. Saphnelo binds to the main receptor that transmits these signals throughout the body, dampening the excessive response found in many people with lupus.

Side Effects and Risks

Like other lupus treatments, biologics can have risks and side effects including:

  • Injection site reactions (e.g., pain, itching, bruising) 
  • Infusion reactions (e.g., headache, itching, dizziness, nausea, flushing)
  • Allergic reactions
  • Low blood counts
  • Symptoms affecting certain organ systems (e.g., heart, GI, lungs, brain)
  • Infections

Some research has suggested that because they suppress the immune system, biologics could increase a person’s risk for cancer. However, more research is needed to understand the possible risk. 

Options for Other Lupus Types 

Other types of lupus may need other types of treatment.

Cutaneous Lupus

If you've been diagnosed with discoid or subacute cutaneous lupus, your plaques should first be treated topically with extra-strength corticosteroid creams or ointments. These creams can be applied to the lesions at night before you go to sleep. However, the treated skin should be covered with a plastic film or Cordran tape. If you don’t cover them, you’ll need to apply corticosteroid ointments and gels twice a day.

If your lesions do not respond to either corticosteroids or calcineurin inhibitors, your provider may try injecting a corticosteroid into your skin lesions.

If none of these treatments work, your provider will likely try a systemic treatment. The first-line therapies that work for most people with lupus include antimalarials such as hydroxychloroquine sulfate, chloroquine, or quinacrine.

If antimalarials do not do the trick, your provider may try one of these systemic treatments:

  • An immunosuppressive, such as methotrexate or mycophenolate mofetil (MMF)
  • A systemic retinoid (such as isotretinoin or acitretin)
  • Dapsone (a sulfonamide)
  • Thalidomide (an immunomodulatory agent)

Drug-Induced Lupus

The main treatment for drug-induced lupus is stopping the drug that caused it. It may take up to 6 months for drug-induced lupus symptoms to go away after the medication is stopped. In the meantime, other treatments that can help with symptoms can also be used.

Complementary or Alternative Medicine

You may want to ask your provider about exploring some complementary or alternative approaches to managing lupus, such as:

  • Special diets
  • Herbal supplements
  • Fish oil supplements
  • Chiropractic care
  • Homeopathy
  • Acupuncture
  • Tai chi
  • Massage therapy
  • Biofeedback
  • Meditation

Although these methods may not do harm and could be beneficial if you combine them with your prescribed lupus treatment plan, there is no research evidence that proves they affect the disease process or prevent organ damage. In fact, herbal supplements can be harmful and can potentially make your lupus symptoms worse and/or interact with your prescription medications.

Always ask your healthcare provider before you start any complementary or alternative treatment, and make sure you keep taking the medications you've been prescribed.

Lifestyle Changes

You can also make some changes in your day-to-day life that may help you deal with lupus symptoms and possibly prevent flares. For example:

  • Avoid smoking or quit if you do 
  • Get plenty of rest and make quality sleep a priority
  • Eat a nutritious diet and stay hydrated 
  • Make sure to protect your skin from the sun by covering up and wearing sunscreen 
  • Take part in regular physical activity that you enjoy and that your provider says is safe for you to do 
  • Find ways to manage your stress
  • Figure out what your lupus triggers are and do your best to avoid them to prevent flare-ups
  • Follow your treatment plan, including taking your medications as prescribed by your provider 

Summary

The best lupus treatment for you will depend on the severity of the disease, your goals for managing the condition, and your other health needs. Your provider will help you come up with a treatment plan that may include a mix of medications and lifestyle adjustments that can make managing lupus easier for you. 

Frequently Asked Questions

  • Can lupus go away?

    There is no cure for lupus, but medication can manage symptoms and even help a person go into remission for periods of time.

  • What is the life expectancy of someone with lupus?

    Lupus does not typically shorten your lifespan. Research shows between 80% and 90% of people who have been diagnosed with lupus continue to live a normal lifespan.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Carol Eustice
Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.