Lupus treatments fall into two main categories: medications that modify the disease and medications that help manage symptoms. Because lupus can cause such a wide variety of symptoms, many different classes of drugs are used to treat it. A few drugs are specifically approved by the U.S. Food and Drug Administration (FDA) for lupus, but several medications approved for other conditions are commonly prescribed off-label.

Treatment guidelines depend on a lot of different factors, including the severity of the disease, the organs or tissues involved, age, overall health, other health conditions, and other medications you might be taking. There are several treatments available specifically to those with lupus nephritis, a condition where lupus antibodies affect and damage the kidneys. Among the broad categories of treatments for lupus are nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), corticosteroids, and medications for managing symptoms. Keep reading to learn more about these treatment options.

Nonsteroidal Anti-Inflammatory Drugs

NSAIDs help reduce fever, mild pain, and inflammation. Common NSAIDs include aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve, Naprosyn). These are available over the counter. Others like celecoxib (Celebrex) and indomethacin (Indocin) require a prescription. NSAIDs work by blocking chemicals that cause inflammation and blood clots. However, if used regularly at high doses, some NSAIDs can lead to gastrointestinal problems, kidney problems, and bleeding issues.

Disease-Modifying Antirheumatic Drugs (DMARDs)

In lupus, the body’s immune system attacks tissues and organs, causing inflammation and damage. DMARDs suppress these immune responses. Some DMARDs are maintenance treatments, which means that you take them regularly to help prevent lupus flares and to slow the disease’s progression. Other DMARDs may be taken only during disease flare-ups. There are several types of disease-modifying medications for lupus.

Antimalarial Drugs

Antimalarial drugs are among the oldest classes of drugs used to treat lupus, and they are still used widely today. Antimalarials are taken orally (by mouth) and include hydroxychloroquine (Plaquenil) and chloroquine.

Immunosuppressants

These drugs are prescribed to suppress immune activity, especially in severe cases that involve the kidneys or lungs. They include:

• Azathioprine (Imuran)
• Methotrexate (Rheumatrex)
• Mycophenolate mofetil (CellCept)
• Tacrolimus (Astragraf XL)
• Voclosporin (Lupkynis)

Chemotherapy Agents

Cyclophosphamide is a chemotherapy drug that is currently approved for use in the treatment of different cancers. It is often used off-label (outside of FDA-approved use) for the treatment of lupus with severe organ involvement, such as lupus nephritis. Cyclophosphamide can be given orally or intravenously (through a vein).

Biologics

Biologics are a newer class of drugs available for treating lupus. Biologics are genetically engineered antibodies (proteins) used by the immune system to identify and neutralize substances. Biologics used to treat lupus include:

• Anifrolumab-fnia (Saphnelo) — Given as an intravenous infusion in a hospital or clinic
• Belimumab (Benlysta) — Can be self-injected at home or administered by your health care team as an intravenous (IV) infusion for systemic lupus erythematosus (SLE) and lupus nephritis
• Rituximab (Rituxan) — Given off-label as an IV infusion to treat lupus

Because all DMARDs suppress parts of the immune system, many of these lupus treatments can increase your risk of contracting infections. Each DMARD carries specific side effects and particular levels of risk. Your doctor can help you understand the risks and benefits of each lupus medication based on your medical history and individual condition.

Corticosteroids

Corticosteroids such as prednisone, dexamethasone, methylprednisolone, and a closely related drug known as repository corticotropin injection (Acthar Gel) can help suppress disease activity during acute flares, or when there is severe kidney or central nervous system (brain and spine) involvement. Corticosteroids, also called steroids, are powerful medications that suppress immune activity and relieve inflammation. They may be administered intravenously or taken orally. In cases of lupus rash, topical corticosteroid creams may also be prescribed.

When taken for short periods, corticosteroids are safe and effective. However, if used for long periods of time, corticosteroids can cause serious side effects including osteoporosis, cataracts, and serious metabolic disorders such as diabetes and Cushing’s syndrome.

Symptom-Management Medications

Lupus symptoms vary, and they can become severe or life-threatening. Although the following medications can help manage some lupus symptoms, they do not treat the underlying disease.

Aspirin

About 50 percent of people with lupus have proteins known as antiphospholipid antibodies (also called lupus anticoagulants) in their blood. These proteins can increase the risk of thromboses (blood clots). Doctors sometimes recommend that certain people with lupus and no previous history of clots take a low dose of aspirin to help prevent blood clots.

Blood Pressure Medications

According to the Johns Hopkins Lupus Center, anywhere from 25 percent to 50 percent of people with lupus have high blood pressure, caused by either the disease or a medication. High blood pressure silently damages organs and raises the risk of stroke and heart attack. Many people with lupus take antihypertensive drugs. Different classes of these drugs include:

• Diuretics (water pills) such as furosemide (Lasix)
• Angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin)
• Calcium channel blockers such as verapamil
• Beta-blockers such as metoprolol

Antidepressants

Antidepressants can help people with lupus deal with depression. Certain antidepressants have been shown to relieve fatigue or neuropathic pain. Some examples of commonly used antidepressants in people with lupus include:

• Citalopram (Celexa)
• Duloxetine (Cymbalta)
• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Venlafaxine (Effexor XR)

Anti-Seizure Medications

When lupus affects the central nervous system, it can cause seizures. Treatment of seizures in people with lupus is highly personalized based on the type of seizure and how frequently they occur, but some examples of the medications that people who experience both lupus and seizures might take include:

• Divalproex sodium (Depakote)
• Gabapentin (Neurontin)
• Pregabalin (Lyrica)

Opioids

If NSAIDs fail to relieve pain caused by lupus, opioids may be necessary. Researchers believe that opioids work on the brain by altering the body’s ability to perceive pain. According to the National Institute on Drug Abuse, regular use of opioids — even as prescribed by a doctor — can lead to dependence. If misused, opioids can cause overdose and death. Two opioids used to treat pain in lupus are oxycodone/acetaminophen (Percocet) and tramadol.

Alternative Treatments

Some people with lupus prefer to try natural treatments and report relief from certain symptoms when they use complementary or alternative treatments such as medical cannabis, dietary supplements, and acupuncture.

Is There a Cure for Lupus?

Currently, there is no cure for lupus. The good news is that although lupus is not currently curable, the prognosis for people with lupus is better than ever. Before modern treatments for lupus, less than 50 percent of people lived for five years after receiving their diagnosis. Today, according to the Lupus Foundation, the five-year survival rate is 95 percent, and the majority of people with lupus live a normal life span.

Can Diet Help Lupus?

Like everyone else, people with lupus feel their best when they consistently eat a healthy, balanced diet. Most physicians who specialize in lupus encourage following the same low-fat, high-fiber diet recommended by the American Cancer Society and American Heart Association. Some people with lupus feel better when they follow popular anti-inflammatory diets, but to date, there have been no clinical studies that prove the benefit of this approach.

Certain foods make lupus symptoms worse. These include garlic, which may strengthen the immune system, and alfalfa sprouts, which contain a protein that may promote inflammation. Drinking alcohol can make some medications less effective and interact dangerously with other drugs (including NSAIDs). People with high blood pressure should minimize their salt intake to avoid serious complications.

Some people with lupus may benefit from dietary supplements if they are low on certain nutrients. For instance, doctors may recommend that people with osteoporosis increase their intake of calcium and vitamin D.

People with lupus nephritis may need to follow a more specific diet to protect their kidney health.

Clinical Trials and Future Treatment

New treatments for lupus are continually being researched. Clinical trials are exploring therapies like stem cell transplants, B-cell therapies, and novel biologics. The latest development in the lupus research field is chimeric antigen receptor (CAR) T-cell therapy, which has been studied extensively in cancer patients. In CAR T-cell therapy, T-cells are collected from the patient and modified to produce receptors that target and destroy other specific cells. Recent research suggests that this approach could be an effective treatment for people with lupus who have not responded to conventional lupus therapies. This innovative therapy is still in early trials for lupus, but it holds potential for long-term remission.

Find Your Support

On MyLupusTeam, the social network for people with lupus and their loved ones, more than 232,000 members come together to ask questions, give advice, and share their stories with others who can relate to their lupus experience.

Are you or a loved one living with lupus? Do you have questions about treatments used for lupus? Share your experience in the comments below, or start a conversation by posting on your Activities page.