by Nicole Evans M.D.

Created on: March 04, 2009

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that has the potential to affect many organ systems of the body. Individuals with SLE can have inflammatory disease involvement of the kidneys, lungs, heart, GI tract, skin, mucous membranes, nervous system, eyes, blood, joints and muscles. Lupus patients have a widely variable symptomatic picture and prognosis depending upon the severity and type of organ involvement. All individuals with lupus must work closely with their doctors to appropriately treat their condition and prevent life-threatening complications.

There are general treatment issues that every SLE patient should consider, as well as a large number of medications used for specific organ involvement.

Non-pharmaceutical management of Systemic Lupus Erythematosus:

1. Sun protection - Avoid exposure to sunlight and other sources of ultraviolet light such as fluorescent and halogen lights. Use a minimum SPF 30 sun screen, preferably those that block both UV-A and UV-B.

2. Dietary supplements -

a. Fish Oil: One placebo-controlled clinical trial has shown a significant reduction in disease activity with fish oil supplementation.
Fish oils cannot be formally recommended for the treatment of SLE based on such limited data. However, a 2 month trial of high quality fish oil is safe and may assist in determining the individual SLE patient's response to omega 3 supplementation.

b. Vitamin D: Long-term treatment with corticosteroids and/or avoidance of sun exposure requires Vitamin D and calcium supplementation to prevent osteoporosis.

c. Multivitamin: A daily multivitamin is only required if you are unable to eat a balanced diet or if you are dieting to lose weight.

3. Smoking cessation - Yet another reason to quit smoking! Cigarette smoking may increase the risk of developing SLE and smokers in general have more active disease.

Pharmaceutical management of Systemic Lupus Erythematosus:

In general, topical preparations are preferred for local problems because this reduce the risk of side-effects. There are topical preparations available for NSAIDs, glucocorticoids and even the immunosuppressant tacrolimus.

1. Nonsteroidal antiinflammatory drugs (NSAIDs)- Generally effective for musculoskeletal complaints and mild serositis.

2. Antimalarials (primarily hydroxychloroquine) - Useful for skin manifestations and musculoskeletal complaints that do not adequately respond to NSAIDs. In addition, these drugs may prevent major damage to the kidneys and central nervous system with long-term use.

3. Glucocorticoids - Prednisone or methylprednisolone is used in patients with with significant organ involvement, particularly renal and central nervous system disease.

4. Immunosuppressive agents - This includes cyclophosphamide, methotrexate, azathioprine, rituximab and mycophenolate. They are often used in patients with moderate to severe kidney involvement, alveolar (lung) hemorrhage, systemic vasculitis, and most patients with significant central nervous system involvement. They are often used after prednisone fails to control disease activity. However, these medications are also used concomitantly with glucocorticoids when required.

As with all medications, response to therapy is improved with compliance to the medication regimen. Some patients may experience side effects to these medications. Rather than taking medications infrequently to avoid these side effects. It is in the SLE patient's best interest to discuss this with their physicians and try different dosing schedule or a different medication altogether.

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