Lupus Disease Severity

Reviewed by: HU Medical Review Board | Last reviewed: January 2020

Lupus symptoms can be very different from person to person, and within the same individual quite different from one flare to the next. One person may experience mild joint pain and severe skin lesions. Another may experience rapid kidney damage (nephritis) and mild rashes.

The type and quantity of drugs your doctor recommends to relieve your symptoms will depend on a variety of factors. Your individual symptoms, the severity of those symptoms, and what drugs have worked in the past all will be part of the equation. Since some medicines used to treat lupus, namely steroids, can cause other health issues, your doctor will weigh the benefits of your medicines with the risks.

The goal of any treatment is to reduce disease activity (flares), slow or stop organ damage, and improve quality of life. While full remission from all symptoms and organ damage is desired it is rarely achieved.

Treatments for mild lupus

In very general terms, your doctor will rate your various lupus symptoms as mild, moderate or severe using a tool such as the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Then your doctor will prescribe medicines and lifestyle changes.1 For mild symptoms, doctors generally prescribe:

  • NSAIDs to control pain and reduce swelling or inflammation.
  • Antimalarials to control lupus overall.
  • Steroids as needed to provide quick control of symptoms during flares.
  • Immunosuppressants for longer-term control of mild-to-moderate lupus symptoms.

While steroids have long been a go-to medicine to treat lupus symptoms, there is growing evidence to support the use of lower doses of steroids and beginning immunosuppressants earlier. One small study in Spain found that lower doses of oral steroids, combined with immunosuppressants, reduced the damage done by long-term steroid use without increasing the damage caused by lupus.2

Treatments for moderate lupus

As your symptoms progress to moderate lupus, your doctor will consider the use of additional medicines to try and control your flares and reduce organ damage. You likely will continue to take NSAIDs for pain and antimalarials for general symptom control, though potentially in larger doses.

Steroids also may be needed in larger doses and used for longer periods of time to achieve faster control of flares while immunosuppressants and the biologic begin to work. There is only one biologic approved specifically for lupus – belimumab.1

While inexpensive and effective in the short-term, steroids can damage organs and create unwanted side effects. This is why your doctor may begin to rely more heavily on immunosuppressants and other types of medicines to control your lupus symptoms.

For instance, calcineurin inhibitors such as tacrolimus help some people with lupus nephritis.1Surgery, such as splenectomy or kidney transplant, may be recommended for certain complications of lupus.

Treatments for severe lupus

As lupus becomes more severe, antimalarials, steroids, and NSAIDs will still be prescribed, often in larger doses than during the mild to moderate stages of the disease. Your doctor will rely more heavily on a variety of immunosuppressants and possibly surgery to stop organ damage and control lupus flares.1

In later severe stages of lupus, the immunosuppressants mycophenolate, cyclophosphamide, and rituximab may be used.1

No matter the stage of your lupus symptoms, any medicines prescribed will have to be judged on benefits versus potential complications.

Treatments for complications of lupus

While your doctor is treating the symptoms of lupus, you will also probably need medicines to control the many complications of lupus. This may include drugs for high blood pressure, high cholesterol, blood clots, osteoporosis, seizures, or depression.1

Supportive lifestyle changes

When you have lupus there are many lifestyle choices you can make to support your health, in addition to taking medicine. Common recommendations include:1

  • Protect yourself from the sun.
  • Get the recommended vaccines.
  • Exercise to keep the joints and bones healthy, and to help control weight.
  • Maintain a healthy weight to help control blood pressure, cholesterol, and blood sugar levels, and make it easier on your joints.
  • Get enough rest and do not push yourself.
  • Quit smoking.

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