Systemic Lupus Erythematosus - Treatment for Cutaneous and Mild SLE

Treatment

No treatment cures systemic lupus erythematosus, but many therapies can suppress symptoms and relieve discomfort. There are also different treatments for the complications associated with lupus. Treatment of SLE varies depending on the extent and severity of the disease.

Only three drugs are currently FDA-approved for the treatment of lupus:

• Prednisone
• Aspirin
• Hydroxychloroquine

However, none of these drugs are the current standard of care. In everyday practice, numerous other drugs are commonly used.

The FDA is considering approving a new drug for lupus and is expected to announce its decision in March 2011. Belimumab (Benlysta) is a biologic monoclonal antibody drug that inhibits a protein called B lymphocyte stimulator. It is given to patients by infusion every four weeks. If approved, belimumab would be the first drug developed specifically for treating lupus, and the first new lupus drug in over 50 years.

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Researchers are conducting many other investigational drug studies, including trials of other biologic drugs.

Treating Mild Systemic Lupus Erythematosus

Less intensive treatments may be effective for symptoms of mild lupus. They include:

• Creams and sunblocks for rashes
• Nonsteroidal anti-inflammatory drugs for fever, arthritis, and headache
• Hydroxychloroquine or similar antimalarial drugs for pleurisy, mild kidney involvement, and inflammation of the tissue surrounding the heart

Treating Severe Systemic Lupus Erythematosus

More aggressive treatment is needed if there is serious disease progression, as evidenced by:

• Hemolytic anemia
• Low platelet count with an accompanying rash (thrombocytopenia purpura)
• Major involvement in the lungs or heart
• Significant kidney damage
• Acute inflammation of the small blood vessels in the extremities or gastrointestinal tract
• Severe central nervous system symptoms

The primary approach to treating severe SLE is to suppress the inflammation and overactive immune system with corticosteroids or immunosuppressant drugs.

Treating Specific Complications

The major complications of the disease must be treated as separate disorders, keeping in mind the specific aspects of SLE.

Pregnancy and SLE

Women with lupus who conceive face high-risk pregnancies that increase the risks for themselves and their babies. It is important for women to understand the potential complications and plan accordingly. The most important advice is to try to avoid becoming pregnant when lupus is active. Research suggests that the following factors predict a successful pregnancy:

• Disease state at time of conception. Doctors strongly recommend that women wait to conceive until their disease state has been inactive for at least 6 months.
• Kidney (renal) function. Women should make sure that their kidney function is evaluated prior to conception. Poor kidney function can worsen high blood pressure and cause excess protein in the urine. These complications increase the risk for preeclampsia (high blood pressure doing pregnancy) and miscarriage.
• Lupus-related antibodies. Antiphospholipid and anticardiolipin antibodies can increase the risks for blood clots, preeclampsia, miscarriage, and stillbirths. Anti-SSA and anti-SSB antibodies can increase the risk for neonatal lupus erythematosus, a condition that can cause skin rash and liver and heart damage to the newborn baby. Levels of these antibodies should be tested at the start of pregnancy. Certain medications (aspirin, heparin) and tests (fetal heart monitoring) may be needed to ensure a safe pregnancy.
• Medication use during pregnancy. Women with active disease may need to take low-dose corticosteroids, but women with inactive disease should avoid these drugs. Steroids appear to pose a low risk for birth defects, but can increase a pregnant woman’s risks for gestational diabetes, high blood pressure, infection, and osteoporosis. For patients who need immunosuppressive therapy, azathioprine (Imuran) is an option. Methotrexate (Rheumatrex) and cyclophosphamide (Cytoxan) should not be taken during pregnancy.

Review Date: 02/18/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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