Treating and managing lupus and preventing flares
The cause remains unclear, and there is currently no cure, but some therapies can help to relieve symptoms, and lifestyle measure can improve a person's quality of life.
There is no way to prevent lupus, but knowing what causes a flare can mean that a person with the condition can be better prepared when they occur.
People should see a doctor if they often experience joint pain and stiffness, skin rashes, especially over the nose and cheeks, and fatigue. Weight loss, swollen glands, sensitivity to light, and poor circulation in the fingers are also signs that may indicate lupus.
Preventing a flare
Treatment is available for lupus, but understanding how to prevent flares of this disease is very important to improve a person's overall quality of life.
Here are some things that may reduce the risk of both the onset of lupus, in those who are at risk, and a flare-up.
Sun protection is important for people with lupus, as UV exposure can trigger symptoms.
Exposure to sunlight can lead to rashes and other symptoms in some people with lupus, including fatigue, and joint pain.
According to research published in 2014, photosensitivity is a common factor in cutaneous lupus erythematosus, and the American College of Rheumatology includes it in its diagnostic criteria for systemic lupus erythematosus (SLE).
Not everyone with lupus has this sensitivity, but it is more common in people with lupus than those without the condition.
For people who have a sensitivity to ultraviolet (UV) light, staying out of the sun can help reduce the risk of a flare-up.
If this is unavoidable, people should use a high-factor sunscreen of 50+ that protects from both UVA and UVB, and wear clothes that cover the body.
Avoid some medications
A number of prescription drugs can trigger symptoms, including:
- the sleep aids melatonin and Rozerem, which mimics melatonin
- the antibiotics Bactrim (which combines sulfamethoxazole and trimethoprim) and Septra (sulfamethoxazole and trimethoprim)
Genetics Home Reference note that in 10 percent of people with lupus, symptoms result from the use of medications. At least 80 medications can cause symptoms.
An individual should always check with their doctor if any new medications are likely to cause a problem.
Avoid certain foods
For a person with an autoimmune condition, enhancing the immune system can be a problem. Foods such as garlic and alfalfa sprouts and supplements such as echinacea may have this property.
People sometimes use such foods and supplements to prevent colds, for example, but people with lupus might find that they make symptoms worse, according to the Johns Hopkins Lupus Center.
Researchers have found that cigarette smoke, alcohol, and some work-related and other chemicals appear to trigger genetic changes that can lead to lupus.
People should avoid these as far as possible.
Once a person has a diagnosis of lupus, the doctor or rheumatologist will develop a treatment plan based on the severity and location of their symptoms, as well as their age, sex, health, symptoms, and lifestyle.
Lupus has many facets, and it affects individuals in different ways. For this reason, the doctor will tailor the treatment plan to the individual's needs. The plan may change over time as the condition develops.
In developing a treatment plan, the doctor will aim to:
- prevent flares
- treat symptoms when flares occur
- reduce the risk of complications, such as organ damage and other problems
Types of medication
Types of medications that people may use to treat lupus include:
- anti-inflammatory drugs, to reduce swelling and relieve pain
- antimalarials, to control symptoms in the long-term
- corticosteroids, including creams for rashes and injections for kidney problems
- immunosuppressants, to reduce immune activity
- hormonal therapies, such as DHEA, a mild male hormone that can treat some symptoms
Some researchers have suggested that, since estrogen levels appear to fluctuate with lupus flares, estrogen therapy might one day be an option. However, more research is necessary before this can happen safely and effectively.
Scientists published findings on a link between lupus and features of the gut microbiota in Applied Environmental Microbiology in 2018. These have led some scientists to predict that, in time, treatment might include fecal transplantation, dietary changes, and the use of live biotherapeutics.
In fecal transplantation, a doctor applies a solution of feces — or poop — from a donor to the gut of another person, to try and change that person's gut flora, or the species in the gut that may be causing a health problem.
A study in mice, published in 2017, indicated that changes in gut microbiota might alter the immune response in people with lupus nephritis.
Live biotherapeutics refer to a type of treatment that contains a live microorganism. A person could use it, for example, to alter the balance of their gut microbiota.
However, there is still some way to go until this happens.
Specific medications may include:
Hydroxychloroquine (Plaquenil): This is an antimalarial drug. It can help to keep mild lupus-related symptoms — such as fatigues, skin, and joint problems — under control.
Cyclophosphamide (Cytoxan): This is a chemotherapy drug with powerful effects that can reduce the activity of the immune system. It can treat severe forms of lupus.
Azathioprine (Imuran): This medication reduces the action of the immune system, for example, in people who have undergone an organ transplant, where there is a risk that the body may reject the transplanted organ. A doctor may prescribe it to treat the severe features of lupus.
Methotrexate (Rheumatrex): This is another chemotherapy medication that can suppress the immune system. Doctors increasingly prescribe it for skin disease, arthritis, and other conditions that have not responded to other drugs.
Cyclophosphamide (Cytoxan) and mycophenolate mofetil (CellCept): These are powerful chemotherapy drugs that can reduce the activity of the immune system. They treat more severe forms of lupus, especially lupus that affects the kidneys.
Belimumab (Benlysta): This is a monoclonal antibody that reduces the activity of white blood cells (lymphocytes) that make autoantibodies.
Rituximab (Rituxan): This is another monoclonal antibody that reduces the activity of white blood cells (lymphocytes) that make autoantibodies.
Lupus is a complex condition. A team of specialists may provide treatment.
At first, a person will probably see their family physician. The physician may then refer them to a rheumatologist. The rheumatologist can deal with inflammation that occurs in the joints due to the immune system not working properly.
Other people who may play a role include:
A team of professionals may include a physical therapist.
- clinical immunologists, who treat immune system disorders
- nephrologists, who treat kidney disease
- hematologists, who treat blood disorders
- dermatologists, who treat skin conditions
- neurologists, who treat problems relating to the nervous system
- cardiologists, who treat heart and blood vessel problems
- endocrinologists, who treat problems related to the glands and hormones
- mental health specialists, as lupus can lead to both depression and a reduction in cognitive function in severe cases
Dietitians, social workers, and other therapists may also be part of the team.
Physical medicine and rehabilitation for lupus may involve:
- physical therapy
- occupational therapy
- speech therapy
- recreational therapy
- combinations of these options
Complementary and alternative therapies
No research to date has confirmed that any specific alternative and complementary therapies can help relieve the symptoms of lupus, slow the disease process, or prevent organ damage.
However, some people recommend:
- special diets
- nutritional supplements, including fish oils
- ointments and creams
- chiropractic treatment
In a review of complementary therapies for lupus, published in 2014 in Current Rheumatology Reports, scientists noted that the following have shown promise in the treatment of systemic lupus erythematosus (SLE):
- vitamin D
- omega 3 fatty acids
- N-acetyl cysteine
They added that cognitive behavioral therapy (CBT) and some types of counseling may help to improve a person's mood and quality of life.
Living with lupus
Lifestyle approaches may help a person to cope with symptoms or reduce some of the stress associated with living with a chronic illness.
Warm packs can help to relieve pain in the joints.
- doing yoga, tai chi, meditation, and other relaxation therapies
- keeping physically active, as far as possible, for example through swimming or walking
- setting priorities for work and ensuring enough rest time
- using a 50+ factor sunscreen that blocks both UVA and UVB rays, and covering up in the sun with a hat and long sleeves
- following a healthful, balanced diet with low salt and sugar content
- applying heat to painful joints or taking a warm bath
- avoiding smoking, as this may trigger symptoms or make them worse
- keeping all medical appointments and following the doctor's instructions
Anyone with lupus who is pregnant or planning to become pregnant should speak to a doctor as soon as possible. There is a risk of pregnancy loss or early delivery if symptoms are active.
Rarely, a mother with lupus-related antibodies can pass these on to an unborn child, who may then be born with neonatal lupus.
Seeking medical advice and support can help to reduce the risk of problems during pregnancy.
Video: This is lupus
In this video, Samantha, who has lupus, discusses how this affects her life.
In the past, lupus was often deadly, but current treatment can relieve symptoms and delay the start of complications, increasing the chance for a normal lifespan.
The United States National Institutes of Health note that, in the future, new ways of diagnosing lupus will mean that treatment can start earlier in the process, increasing the chances of reducing the long-term impact.
The individual may find it helpful to join a local support group. A health worker may be able to advise on facilities.
A doctor may also be able to advise on any clinical trials that are available. These can give access to new and experimental medications, for people who would like to try them.
Find out more about lupus in our main article: What is lupus?