Understanding the New Treatment Recommendations for Systemic Lupus
By: Dr. Robert Katz, Rheumatologist
The American College of Rheumatology (ACR) has established updated recommendations for the treatment of systemic lupus erythematosus (SLE). The overall goal of treatment is to control lupus activity, prevent permanent organ damage, reduce symptoms, and minimize the long-term side effects associated with medications such as steroids.
Hydroxychloroquine should generally be a standard therapy for people with lupus unless there is a medical reason it cannot be used. The dose is individualized based on factors such as body weight and other considerations, and regular eye monitoring is important.
Steroids are primarily used to quickly control inflammation during the initial treatment of lupus or during disease flares. When possible, the goal is to taper steroids as quickly and safely as possible and use the lowest effective dose to reduce the risk of long-term side effects.
For patients with ongoing disease activity, immunosuppressive medications may be introduced early. These can include conventional medications such as azathioprine (Imuran), mycophenolate (CellCept), or methotrexate. Biologic therapies, including belimumab (Benlysta) and anifrolumab (Saphnelo), may also be appropriate for some patients with active lupus.
For severe or organ-threatening lupus, treatment needs to begin urgently and may include high-dose steroids combined with immunosuppressive therapy. In certain severe cases, including some patients with life-threatening or neuropsychiatric lupus, cyclophosphamide (Cytoxan) may be considered.
Treatment also depends on which organs are affected. For cutaneous (skin) lupus, topical steroid treatments and hydroxychloroquine may be recommended. Some patients may also require oral steroids or medications such as methotrexate, anifrolumab, or belimumab.
The long-term goal is to achieve and maintain low disease activity or remission while preventing irreversible organ damage. Once lupus has been well controlled for an extended period, doctors may consider gradually reducing certain immunosuppressive medications when appropriate.
The good news is that there are now many effective treatment options for lupus. In addition to hydroxychloroquine and steroids, patients may benefit from immunosuppressive medications and newer biologic therapies such as Benlysta and Saphnelo. Treatment should always be individualized and discussed with a rheumatologist based on the person’s symptoms, organs involved, disease activity, and other health considerations.
For the most current recommendations, patients and families can visit the American College of Rheumatology website and look for the latest lupus treatment guidelines.
