A Look at Lupus Treatment Options


Lupus Treatment

A Look at Lupus Treatment Options

The Lupus Foundation of America estimates that 1.5 Americans have lupus, with approximately 5 million people worldwide also having a form of lupus. It is most common in women of childbearing age, but it does not discriminate – it can affect men, children, and teenagers as well.

A 2008 study published in Arthritis & Rheumatology indicated that the annual health care costs for a person with lupus was approximately $12,643 – add in the total cost of a loss of productivity (meaning a loss of work) for $8,659, and the annual total cost of lupus is approximately $20,924.

The bulk of that cost is the treatment.  Unfortunately, lupus treatment is multifaceted, because lupus can target multiple organ systems.

Below, we’re going to investigate various treatment options for lupus – the traditional medical approach to treating lupus, alternative medical options, and natural treatment options.

Traditional Medical Lupus Treatment

By now, you likely understand that lupus is an autoimmune disease that is systemic; this means that it can affect the entire body. As such, treatment must be individualized because it must “fit” each person’s individual lupus symptoms and pathophysiology.

Here are the most common medications used to treat lupus:

  • Antimalarial drugs: These drugs, which are most commonly used to treat malaria, affect the immune system and are known to reduce the amount of lupus exacerbations. An example of an antimalarial medication is hydroxychloroquine (Plaquenil).  These medications can cause gastrointestinal upset, and rarely, retinal damage. As such, if prescribed, your physician will recommend regular eye exams.
  • Corticosteroids: These drugs are known to reduce inflammation in general, and high doses can be used to treat inflammation of the kidneys and the brain. Examples of corticosteroids include prednisone and methylprednisolone (A-Methapred, Medrol).  Despite their effectiveness at reducing inflammation, corticosteroids are fraught with side effects, including weight gain, elevated glucose levels, high blood pressure, thinning bones, and an increased risk of fracture.  These risks are increased with long-term use.
  • Immunosuppressants: In more serious cases of lupus, an immunosuppressant may prove beneficial. Examples of immunosuppressants include azathioprine (Imuran, Azasan), mycophenolate mofetil (CellCept) and methotrexate (Trexall).
  • Biologics: Intravenous medications, this drug class can also help to reduce lupus symptoms. Examples include belimumab (Benlysta) and rituximab (Rituxan).  Rituxan is typically reserved for more resistant cases of lupus.  Symptoms of biologics include nausea, diarrhea, and infections.  In rare cases, worsening depression can occur.
  • Nonsteroidal anti-inflammatory drugs: For pain associated with lupus, NSAIDs that can be purchased over the counter are the drug of choice. NSAIDs can treat fevers, reduce inflammation, and can treat pain – a triple threat!  Examples include ibuprofen (Advil, Motrin IB) and naproxen (Aleve). For resistant symptoms, stronger NSAIDs can be prescribed.  NSAIDs have been associated with gastrointestinal bleeding, an increased risk of heart problems, and an increased risk for kidney problems.

Dehydroepiandrosterone

All of the above medications are FDA-approved medications for the treatment of lupus.  Occasionally, a medication is used “off-label”, which means that it is used without FDA-approval because the pros outweigh the cons and it is still thought to be effective.  An example is the use of DHEA (dehydroepiandrosterone) to treat lupus.

DHEA is a mild male hormone that has been found to be effective to treat mild to moderate lupus – specifically lupus symptoms that include hair loss, fatigue, cognitive dysfunction, joint pain, and fatigue.  It has the added bonus of preventing osteoporosis.  Because it is a hormone, it does have side effects, which include acne, oily skin, facial hair growth, and excessive sweating.

DHEA is also contraindicated in certain patient populations: men, women who are pregnant, trying to become pregnant, or who are breastfeeding, and those with a cancer that may be influenced by hormones. Post-menopausal women who are prescribed DHEA should be monitored.

Although these are the common medications to treat lupus, your physician may use other medications to treat your condition.  As we’ve discussed, lupus can affect different body systems, therefore your treatment plan may require a varied medication profile.

For example, if lupus has affected your blood pressure due to weight gain and/or long-term steroid use, your physician will likely prescribe an antihypertensive medication to reduce your blood pressure.

Next page: alternative lupus treatment and natural lupus treatment options. 

Alternative and Natural Medical Lupus Treatment

Complementary and alternative medicine (CAM) is “a set of health systems, practices, and products that are not generally considered to be part of conventional medicine. CAM consists of natural products (vitamins, herbs, and supplements), mind and body medicine, and manipulation and other body-based practices, as well as alternative medical systems such as traditional Chinese medicine, ayurvedic medicine, and homeopathy.”

It has been estimated that upwards of 50 percent of lupus patients utilize or have utilized CAM therapies to reduce the symptoms associated with lupus.  However, there are few research studies to indicate the effectiveness of CAM for lupus.

If you’re reading this and are wondering, “There’s gotta be something else out there for me!” but at the same time are thinking, “Alternative therapies may be a bit too weird,” you should know that CAM therapies are utilized heavily in not just lupus patients, but in the general population and they are no longer weird. 

As we’ve already discussed, at least 50 percent of lupus patients utilize CAM therapies, 40 percent of adults in the US are actively using a CAM therapy, and 70 percent will use a CAM therapy at some point in their life.

That being said, that doesn’t mean you should go out and utilize every type of treatment available!

Here’s a review of several of the most prevalent and promising CAM therapies.

Supplements

We know that you’ve already been prescribed medications to treat lupus, but there are several supplements that may be beneficial to your health:

  • Vitamin D has been found to be deficient in many people in general- but even more so in patients with lupus. A Hungarian study evaluated 177 patients with lupus and found that 82 percent – yes, over three-quarters of the study participants – suffered from low vitamin D levels.  In an Egyptian study, researchers believe that vitamin D supplementation “may improve disease activity and modulate proinflammatory and hemostatic markers.” Also, for a variety of conditions. According to Kaleidoscope Fighting Lupus, “In recent testing, high doses of vitamin D were safe and appeared to temper some of the destructive immune system responses believed to cause lupus. Research is pointing to an immune-regulating role for vitamin D.”
  • Omega-3 fatty acids/fish oil is useful in the general population because it has been established to be cardioprotective and have anti-inflammatory effects – both of which are also a boon to our lupus patients. In one research study, study participants were given fish oil supplements daily for 24 weeks.  At the completion of the study, Systemic Lupus Activity Measure-Revised (SLAM-R) had declined significantly, indicating an improvement in functioning.
  • Turmeric is a popular spice – but it can also be used as a supplement. In fact, it has been used for years to treat a variety of conditions but has only recently gain traction as a reputable treatment.  Curcumin is the active component in turmeric.  Turmeric is known to “inhibit tumor growth, inflammatory cytokine production, and inflammatory bowel disease, and curcumin can lower cholesterol and enhance wound healing.”  An Iranian study evaluated the usage of turmeric in lupus patients, specifically those with relapsing or refractory lupus nephritis.  The control group noticed no differences, while the patients who were given turmeric were noted to have a reduction in proteinuria, systolic blood pressure, and hematuria.
  • Flaxseed contains a component called alpha-linolenic acid. Alpha-linolenic acid is a fatty acid that may reduce inflammation in the body.  In people with lupus, this supplement is thought to be beneficial, especially for lupus nephritis, which is kidney inflammation that is related to lupus.
  • Vitamin A is also beneficial in reducing inflammation in the body – specifically the intestines, skin, and lungs. People who are deficient in vitamin A may also have inflammatory bowel disease, acne, and lung diseases.  It is a known antioxidant that is often found in milk, liver, and fortified foods.  It has a special relationship with beta-carotene – beta-carotene is turned into vitamin A in the body.
  • Vitamin E is another of the alphabet vitamins that is thought to be helpful in treating lupus. However, the verdict is still out – the studies have only been performed on animals.  That being said, alpha-tocopherol, a form of vitamin E, is thought to prevent heart disease because it prevents the release of inflammatory substances that are known to cause heart damage.
  • Boswellia extract is an ancient medicinal treatment. In fact, the active ingredient in Boswellia extract is frankincense, which is known in the Bible as a gift to the baby Jesus.  Frankincense is a known anti-inflammatory agent because it reduces the body’s production of leukotrienes.  It has successfully treated inflammation in lupus, as well as Crohn’s disease, fibromyalgia, rheumatoid arthritis, and osteoarthritis.

Acupuncture

Acupuncture has been highly evaluated in various chronic illnesses, but few studies have evaluated the effect on lupus patients.

One study did evaluate the effectiveness of acupuncture for the reduction in pain and fatigue in SLE patients. The study assigned participants to continue their usual medical care as well as 10 sessions of acupuncture and 10 sessions minimal needling, where needles were inserted into the skin in areas that were not known to be acupuncture points.

The study found that both acupuncture and minimal needling had a reduction in pain – 40 percent and 30 percent respectively. Why? Researchers suspect that when “needles are inserted can elicit a non-specific analgesic effect [52] or because treatment did not last long enough.”

It is reasonable to believe that acupuncture is a safe treatment for pain and fatigue, but that further studies are needed for evaluation.

Next page: More natural and alternative lupus treatments, dietary changes and more. 

Alternative and Natural Medical Lupus Treatment

Mind-Body Treatments

According to Current Rheumatology Reports, “Mood disorders affect up to 65 percent of SLE patients over their lifetimes and the rate of psychiatric disorders are higher in SLE than in other chronic, inflammatory autoimmune diseases, such as RA and ankylosing spondylitis.”

Because of the high rates of mood disorders in lupus patients, mind-body treatments are often recommended by providers.

Not only are these mind-body interventions thought to be effective at improving the symptoms of mood disorders, they can also improve symptomology of lupus – “Mind–body interventions for SLE may be focused on reducing pain, stress, anxiety, and fatigue, and consist of skills training in physiologic relaxation, meditation, problem-solving, and assertive communication skills and identifying and modifying distorted or unhelpful thinking styles.”

Effective mind-body therapies include:

  • Cognitive behavioral therapy (CBT) is a specific type of therapy that improves the symptoms of depression and anxiety. Recently, it has been studies in patients with SLE and cutaneous lupus.  In 2010, 45 patients with SLE and cutaneous lupus each were assigned 10 sessions of CBT or to their usual medical care.  They were followed over the course of 15 months.  At the conclusion of 15 months, the group who was assigned CBT had reduced stress, depressive symptoms, and anxiety than that of the control group, although this did not lead to a reduction in exacerbations.
  • Meditation has been shown to improve immune function. In addition, those who have been trained in Mindfulness-Based Stress Reduction (MBSR), which is an 8-session program that focuses heavily on meditation, seem to have a reduced psychological stress and pain in those with rheumatoid arthritis and osteoarthritis.  There is, unfortunately, little research on the effect of meditation in those with lupus.
  • Yoga is known to help reduce stress – and it is well-known that stress promotes inflammation and increases pain! Yoga can also maintain limber joints.  Make sure that you take a yoga class with an instructor who is knowledgeable in modifications that may be necessary to ensure your safety.

Dietary Changes

The treatments discussed above are either traditional medical treatments or CAM treatments that directly treat lupus and/or the symptoms of lupus – research shows these treatments efficacy.

But what about dietary changes?  Is there any merit to changing one’s diet to improve lupus?

These days, you can’t watch the news, flip through a magazine, or scroll through Facebook without seeing a news story or an advertisement about a new diet.  We’re quick to start the latest fad diet.

But then there’s the old adage – “You are what you eat.”

What if treating lupus was effective with a combination of all of the aforementioned treatments, as well as a well-planned diet?

Kaleidoscope Fighting Lupus notes that two specific diets are trending in the “autoimmune world” right now – the anti-inflammatory diet and the Paleo diet.  Let’s take a look at both diets:

  • The anti-inflammatory diet is “intended to provide steady energy, plenty of vitamins and minerals, and the essential fatty acids needed to maintain optimum health.” This “diet” is designed to avoid inflammation in the body.  To put it simply, this diet is rich in fruits and vegetables, omega-3 fatty acids (such as fish or supplements), whole grains, lean protein sources, full-fat dairy sources, and avoiding processed foods.
  • Paleo diet is “based around focusing on foods that have been eaten by humans for thousands of years during their evolution. Foods that existed before the introduction of agriculture. These foods are fresh and free of any added preservatives, mainly consisting of vegetables and meats.” Proponents of the Paleo diet believe that it heals the immune system.  In addition to a diet rich in vegetables and meats, healthy fats are included, while dairy products, sugar, and grains are eliminated.

What does science say about these two diet plans? Not a whole lot! These diets are very little research that indicates that either of these diets stops lupus from progressing or improves symptoms. However, you can discuss the diet plan (or another diet plan of your choosing) with your physician to ensure that it is “right” for you.

The Bottom Line…

There are a lot of factors to consider when selecting treatment for lupus. From traditional medicine for managing symptoms to alternative options for easy the mental and emotional health of living with lupus.

Generally, a traditional medication will be required to maintain health. Should you choose to supplement, ensure that what you select does not interact with your medications. 

If you’re interested in trying a different type of medication or treatment option for your lupus, be sure to consult your doctor first before beginning or taking anything new. Working closely with your health care team will help you find the right treatment and cater towards your symptoms and to prevent further complications lupus may bring.

While living with lupus isn’t always easy, it’s important to not give up.

Resources

Johns Hopkins Medicine (Treating Lupus with DHEA)

Kaleidoscope Fighting Lupus (Alternative Lupus Treatments and Therapies)

Kaleidoscope Fighting Lupus (The Paleo and Anti-Inflammatory Diet: What You Should Know)

Mayo Clinic (Lupus – Diagnosis & Treatment)

The National Resource Center on Lupus (Lupus Facts and Statistics)

US National Library of Medicine National Institutes of Health (Updated Review of Complementary and Alternative Medicine Treatments for Systemic Lupus Erythematous)

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