Introduction

Systemic lupus erythematosus, or lupus, is a chronic autoimmune disease. In autoimmune diseases, your immune system attacks itself. Lupus causes the immune system to mistake healthy tissues for germs, viruses, and other invaders. The system then creates autoantibodies that attack your body’s own organs.

This attack can affect many parts of your body and often causes symptoms. Lupus can affect your joints, organs, eyes, and skin. It can cause pain, inflammation, fatigue, and rashes. The condition goes through times when it’s more active, which are called flares or flare-ups. You may have more symptoms during these periods. Lupus also goes through times of remission. These are times of decreased activity when you may have fewer flare-ups.

Read more: How to identify the 10 early signs of lupus »

There’s no cure for lupus yet, but certain drugs can ease your symptoms. The symptoms of lupus and their severity can vary among people, so you’ll need to work with your doctor to create a care plan that’s right for you. To get started, learn about the types of medications that can treat your lupus symptoms.

Corticosteroids, also called glucocorticoids or steroids, can help treat symptoms of lupus. These drugs mimic how cortisol works. Cortisol is a hormone that your body makes. It helps fight inflammation and controls your immune system. Regulating your immune system can ease symptoms of lupus.

Steroids include:

In general, steroids are effective. But like all drugs, they may sometimes cause side effects. These can include:

  • weight gain
  • fluid retention or swelling
  • acne
  • irritability
  • trouble sleeping
  • infections
  • osteoporosis

Steroids often work quickly. Your doctor may give you a short steroid treatment until your longer-term drugs start working. Doctors try to prescribe the lowest possible dosage of a steroid for the shortest length of time to avoid side effects. When you need to stop taking steroids, your doctor will slowly reduce your dosage over time to reduce your risk of side effects.

NSAIDs are used to treat pain, inflammation, and stiffness due to lupus. These medications are available as over-the-counter (OTC) and prescription drugs. If you have kidney disease from lupus, talk to your doctor before taking an NSAID. You may need a lower dosage or your doctor may want you to avoid these medications.

OTC NSAIDs include:

  • aspirin
  • ibuprofen (Motrin)
  • naproxen

Prescription NSAIDs include:

  • celecoxib (Celebrex)
  • diclofenac (Voltaren)
  • diclofenac-misoprostol (Arthrotec) (Note: misoprostol is not an NSAID. It helps to prevent stomach ulcers, which are a risk of NSAIDs.)
  • diflunisal (Dolobid)
  • etodolac (Lodine)
  • fenoprofen (Nalfon)
  • flurbiprofen (Ansaid)
  • indomethacin (Indocin)
  • ketorolac (Toradol)
  • ketoprofen (Orudis, Ketoprofen ER, Oruvail, Actron)
  • nabumetone (Relafen)
  • meclofenamate
  • mefenamic acid (Ponstel)
  • meloxicam (Mobic Vivlodex)
  • nabumetone (Relafen)
  • oxaprozin (Daypro)
  • piroxicam (Feldene)
  • salsalate (Disalcid)
  • sulindac(Clinoril)
  • tolmetin (Tolmetin Sodium, Tolectin)

The most common side effects of these NSAIDs include:

  • nausea
  • heartburn
  • ulcers in your stomach or intestines
  • bleeding in your stomach or intestines

Taking a high dosage of an NSAID or using these drugs for a long time increases your risk of bleeding or stomach ulcers. Some NSAIDs are gentler on the stomach than others. Always take NSAIDs with food, and never take them right before lying down or going to sleep. These precautions can reduce your risk of stomach problems.

Acetaminophen

OTC drugs such as acetaminophen (Tylenol) can offer some relief from your lupus symptoms. These drugs can control pain and reduce fever. In general, acetaminophen may cause fewer intestinal side effects than prescription drugs. But it may also cause kidney and liver problems. Ask your doctor what the right dosage is for you. Taking the correct dosage extra important if you have kidney disease from lupus. You may be more sensitive to the side effects from acetaminophen.

Opioids

If NSAIDs or acetaminophen don’t relieve your pain, your doctor may give you an opioid. These drugs are prescription pain medications. They’re powerful and can be habit-forming. In fact, these drugs aren’t normally a first-line treatment for lupus because of the risk of addiction. Opioids can also make you very sleepy. You should never take these drugs with alcohol.

These drugs include:

  • hydrocodone
  • codeine
  • oxycodone

Learn more: Understanding hydrocodone addiction »

Tramadol (Ultram)

Tramadol (Ultram) is a prescription pain drug. It acts like both an opioid pain reliever and an antidepressant. It can help ease short-term pain from lupus. Like opioids, this drug is habit-forming and can make you sleepy. You shouldn’t take it with alcohol.

Disease-modifying anti-rheumatic drugs (DMARDs)

These drugs are used to treat certain autoimmune diseases. They work by suppressing an overactive immune system. This reduces inflammation caused by lupus, which can help relieve symptoms. DMARDS often are used with NSAIDs.

These drugs include:

Antimalarials

These drugs were first approved to treat malaria. They decrease autoantibody production in your body. This effect reduces the damage lupus can do to your organs. These drugs also help ease lupus symptoms.

These medications can take several months to be effective, so they’re only given after other drugs don’t work. Side effects are usually mild. However, these drugs can cause vision changes in some people. If you take any of these drugs, you need to have your vision checked as often as your doctor suggests.

Antimalarials for lupus include:

  • chloroquine (Aralen), used off-label
  • hydroxychloroquine (Plaquenil)

BLyS-specific inhibitors or monoclonal antibodies (MAbS)

Belimumab (Benlysta) works by suppressing autoantibodies in people with lupus. This helps to improve lupus symptoms. This drug was approved in 2011. It was the first drug created specifically for lupus in 50 years. This type of drug has shown to be helpful, but more research is needed to know how well it works long-term.

Immunosuppressive agents and immune modulators

In advanced cases of lupus, these drugs might be used to suppress the overactive immune system. These drugs include:

  • azathioprine (Imuran)
  • methotrexate (Rheumatrex)
  • mycophenolate mofetil
  • cyclophosphamide (Cytoxan)

Your doctor may prescribe these drugs when other medications haven’t worked to control your symptoms. These drugs aren’t a first-line treatment for lupus because they have potentially severe side effects. Your doctor will monitor you closely for side effects during treatment if you take any of these drugs. These effects can include:

  • liver damage
  • infections
  • certain types of cancer
  • infertility in men and women
  • sun sensitivity
  • hair loss

Anticoagulants

People with lupus have a higher risk of blood clots. If your doctor decides you need preventive treatment, they may give you a drug to thin your blood. Anticoagulants do not treat lupus specifically but may be a part of your lupus care. If your doctor gives you one of these drugs, they will watch you closely to make sure your blood doesn’t become too thin.

These drugs include:

  • low-dose aspirin
  • heparin (Calciparine, Liquaemin)
  • warfarin (Coumadin)
  • dabigatran (Pradaxa)
  • apixiban (Eliquis)
  • edoxaban (Savaysa)
  • rivaroxaban (Xarelto)

Many medications are available to treat lupus. They don’t all work in the same way. Some relieve pain, inflammation, and other symptoms, while others work by suppressing your immune system. The symptoms and severity of lupus can vary among people, so talk to your doctor about your options. You and your doctor can create a care plan that’s right for you.