Lupus Site - a guide for lupus patients and their families

The types of drugs used in lupus can be broadly divided into those which treat the disease itself (e.g. antimalarials) and those used for other problems sometimes associated with lupus (e.g. blood pressure tablets).

Non-steroidals

These are the standard drugs used for rheumatic pains. There are many to choose between and they have a good safety profile. They are designed to lower inflammation and are, therefore, widely used in all the rheumatic diseases. The main drawback is that they are prone to cause indigestion, especially in older patients.

Anti-malarials

The drug hydroxychloroquine (Plaquenil) is widely used for lupus. It has a number of properties which make it potentially useful, having anti-inflammatory properties, some sun-protective properties and the property of giving some protection against clotting. The older drug chloroquine used to be more widely used but there is a suspicion that higher doses could cause eye (retinal) damage. Recent studies with hydroxychloroquine at a dose of one tablet (200mg) daily show that the risk of retinal disease is minimal. Antimalarials are particularly useful for skin rashes, for joint pains and for helping the fatigue of lupus.

Corticosteroids (prednisolone)

These are life-saving in acute lupus and have totally changed the outcome of the disease. Modern treatment is geared to reduce the dose as much as possible and it is now known that the majority of lupus patients can be either maintained on a low dose or even weaned off the drugs altogether. The side-effects of steroids are well known and include weight gain and “moon” face, muscle weakness and, over a period of time, bone softening or osteoporosis.

Immunosupressives

The two most widely-used drugs are azathioprine and cyclophosphamide. Azathioprine is a milder immunosuppressive and is used for mild to moderate kidney disease or where it is proving difficult to reduce the steroid dosage. Cyclophosphamide, now always given if possible as an injection or “pulse”, is widely used for kidney disease and to a lesser extent for severe neuropsychiatric disease, It is a very effective drug and the newer regimes using lower doses by injection have a much higher safety profile. Major side-effects of cyclophosphamide are a reduction in white cell count and, with the use of higher doses, failure of the ovaries or sperm-producing cells in males.

Other drugs

Other drugs are less frequently used in lupus and include intravenous immunoglobulin (often used when the platelets are low) and cyclosporin A, the drug widely used in transplantation medicine to suppress rejection, For very severe skin disease in patients where pregnancy is not a consideration, thalidomide has proved an extremely powerful medication.

Non-lupus drugs

Various medications have helped improve the prognosis in lupus. These include a variety of improved blood pressure tablets and diuretics, anticoagulants (aspirin or warfarin) in those patients with a clotting tendency, anti-epileptic and anti depressive medication. Skin creams include corticosteroids and newer, vastly improved sun-protection creams. Patients who have received long-term steroids are a increased risk from osteoporosis, There are now, in addition to standard calcium and vitamin D preparations, modern effective drugs for the prevention and treatment of osteoporosis.

Finally, HRT (hormone replacement therapy and the Pill. The majority of young women with lupus suffer no problems on the oral contraceptive pill. However, it is now recognised that those women with antiphospholipid antibodies are at increased risk of thrombosis or migraine when taking the pill. Perhaps surprisingly, hormone replacement therapy, often given to treat osteoporosis in post-menopausal lupus patients, is generally well tolerated with few side-effects.