There is currently no cure for systemic lupus erythematosus (SLE). However, treatments are available that can help to ease your symptoms and minimise the effect that the condition has on your daily life.
Protecting yourself from the sun
Exposure to sunlight can sometimes make SLE symptoms such as skin rashes worse. Therefore, it is important to make sure you protect your skin when you are out in the sun.
This means wearing clothing that covers your skin, including a wide-brimmed hat and sunglasses. When you are out in the sun, you also need to apply sun screen with a high factor to help reduce your risk of having a flare-up.
If your SLE symptoms are very mild, you may not need any specific treatment. However, most people will require some sort of medication to help them to manage their symptoms.
Some of the medicines that you may need if you have SLE are described below.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are a form of painkilling medication that reduce inflammation in the body.
If you experience joint or muscle pain as a result of SLE, you may be prescribed a NSAID to help ease your symptoms.
Commonly prescribed NSAIDs for SLE include:
- ibuprofen
- naproxen
- diclofenac
- piroxicam
You can buy some NSAIDs, such as ibuprofen, over the counter. These NSAIDs may be suitable if your joint or muscle pain is mild. However, if your pain is more severe, you will need stronger medication prescribed by your GP.
NSAIDs may not be suitable for people who have stomach, kidney or liver problems or have had these problems in the past. They may also be unsuitable for people with asthma. Children under the age of 16 should not take aspirin. Your GP will be able to advise you about which NSAID is right for you.
If taken in high doses or over long periods of time, NSAIDs can damage your stomach lining, which may cause internal bleeding. If you need to take NSAIDs on a long-term basis, your GP will carefully monitor your condition to ensure that the medication is not causing bleeding from your stomach. However, if this occurs other options are available.
Hydroxychloroquine
Hydroxychloroquine is a type of medicine that is usually used to treat malaria but it is also effective in treating some of the symptoms of SLE, such as skin rashes, joint and muscle pain and fatigue.
You will usually have to take hydroxychloroquine for 6–12 weeks before you start to notice any benefit.
Many people with SLE take hydroxychloroquine on a long-term basis as a way of controlling their symptoms and helping to prevent flare-ups.
Side effects of hydroxychloroquine are rare but may include:
- indigestion
- diarrhoea
- headaches
- skin rashes
Hydroxychloroquine has also been known to cause more serious side effects in a small number of people. For example, approximately one in 2,000 people taking this medicine may experience damage to their vision. It is worthwhile having a baseline eye check at you local ophthalmic optician but, as side effects are so rare, routine monitoring in an eye clinic is no longer recommended.
Contact your GP or specialist immediately if you experience vision problems while taking hydroxychloroquine.
If your GP or specialist feels it is necessary, you may need to have regular eye examinations to help reduce your risk of developing complications.
Corticosteroids
Corticosteroids are a type of medicine that helps to reduce inflammation quickly. They are are very effective but are usually only prescribed if you have severe SLE.
If you have severe symptoms of SLE, or if you are experiencing a flare-up, you may be given a large dose of corticosteroids to help bring your symptoms under control. As your symptoms ease, your dosage can gradually be reduced.
When prescribing corticosteroids, the lowest effective dosage is always given. This is because high doses or long-term use of corticosteroids can cause side effects. These may include:
- thinning of your bones
- thinning of your skin
- weight gain
- muscle wasting
- high blood pressure (hypertension)
- high blood sugar (with tendency to diabetes)
Corticosteroids are a safe and effective form of treatment provided that they are taken correctly and under the careful supervision of your GP or specialist. They will tailor the steroid dose to your disease activity to minimise side effects while effectively controlling the condition.
Corticosteroids are not the same as anabolic steroids, which are sometimes used by athletes and bodybuilders to improve their performance.
Immunosuppressants
Immunosuppressants are a type of medicine that suppress your immune system. They can help improve your symptoms of SLE by limiting the damage that your immune system causes when it attacks the healthy parts of your body.
Commonly prescribed immunosuppressant medicines include:
- azathioprine
- mycophenolate mofetil
- cyclophosphamide
Immunosuppressants are sometimes used in conjunction with corticosteroids (see above) because these medicines may ease your symptoms more effectively when used together. In addition, use of immunosuppressant medication may reduce the dose of corticosteroids that is needed.
Immunosuppressant medication is usually only prescribed if you have severe SLE. This is because this type of medication is very powerful and can cause side effects such as:
- loss of appetite
- nausea
- vomiting
- stomach pain
- diarrhoea
- swollen gums
- bruising or bleeding more easily
- convulsions
- dizziness
- headache
- acne
- extra hair growth
- weight gain
The exact side effects will depend on which immunosuppressant is prescribed. Tell your GP if a side effect becomes particularly troublesome because your dose may need adjusting.
Mycophenolate and cyclophosphamide can cause birth defects in women, so you should use a reliable form of contraception if you are taking these medications and you are sexually active.
If you are trying to become pregnant, an alternative medication such as azathioprine can be used. Pregnancy should be planned in consultation with your specialist during a time of when SLE is in remission (a period when there is a decrease in symptoms). Close monitoring by your specialist and your obstetrician will be essential during pregnancy.
Suppressing your immune system increases your risk of developing infections. Immunosuppressants can also sometimes cause liver damage. For these reasons, you will need to have regular check-ups and blood tests when you are taking immunosuppressant medication.
Report any symptoms of an infection to your GP immediately, because you may need prompt treatment to prevent serious complications from occuring.
Symptoms of infection include:
- high temperature (fever) of 38C (100.4F) or above
- new onset of cough, phlegm or breathlessness
- burning on passing urine or blood in the urine (haematuria)
- diarrhoea
- headache plus fever
You should avoid contact with anyone who is known to have an infection even if it is an infection that you were previously immune to, such as chickenpox or measles. This is because your previous immunity to these conditions will probably be suppressed (lowered).
Rituximab
Rituximab is a new type of medication that can treat people with SLE who don't respond to the medications listed above.
Rituximab was originally designed to treat certain types of blood cancer, such as lymphoma. However, it has since proved to be effective in treating a number of autoimmune conditions, such as SLE and rheumatoid arthritis.
Rituximab works by locking on to and killing the B-cells, which produce antibodies that are responsible for the symptoms of SLE. It is administered directly into your vein over the course of several hours. This is known as an infusion.
Common side effects of rituximab include:
- flu-like symptoms, such as chills and a high temperature while the medication is being given
- dizziness
- nausea
- vomiting
In rare cases, rituximab can cause infusion reactions. Most infusion reactions occur during or shortly after the administration of the infusion treatment. You will therefore be closely monitored once your treatment begins.
If you start to experience the symptoms of an infusion reaction, such as rash, shortness of breath or chest pain, anti-allergy medicines such as anti-histamines and corticosteroids can be used to help relieve your symptoms.
It is important to stress that rituximab is currently unlicensed for treating SLE in the UK. This means that clinical trials carried out on the use of rituximab have not led to the medication being issued with a license for use in treating SLE in the UK. A clinical trial is a type of research that tests one treatment against another or a dummy treatment (placebo) to assess how effective and safe a new treatment is.
People with the condition should be aware that there are uncertainties about how effective or safe rituximab is in treating SLE. However, although rituximab is unlicensed, there may be instances where your specialist may consider it to be an appropriate treatment for you.
