Tips for Lupus Treatment

Published: July 28, 2022
Barbara Young
By Barbara Young, PharmD

Lupus is an autoimmune disease that causes damage when the body attacks its own tissues. There are several different types of lupus, but the most common type is systemic lupus erythematosus. It affects many body parts including your joints, skin, kidneys, heart, lungs, blood vessels, and brain.

Is lupus a serious disease?
It can be, especially for your kidneys, because it can cause severe kidney damage. Lupus is an ongoing condition that may be controlled with treatment, but not cured. Symptoms may vary over time with good periods followed by flare-ups when the symptoms return or worsen.

What are the symptoms of lupus?
You may first notice symptoms such as tiredness and joint pain – complaints that could be associated with many conditions. And because these symptoms may come and go, it often makes it difficult for your doctor to diagnose this condition at first.

Your doctor will order lab tests to see if you have lupus. Over time, lupus may start to affect other parts of the body, and you may experience symptoms such as fever, muscle and joint pain, chest pain, hair loss, sun and light sensitivity, mouth sores, dry eyes, and fatigue or tiredness. Your doctor will also monitor you closely to make sure lupus doesn’t being to affect your kidneys or cause you to have clots.

Who is most at risk for lupus?
Lupus is most common in Black women between the ages of 15 and 44. Lupus is ten times more likely to be found in women than in men. It is three times more likely to be diagnosed in Black women than white women. Lupus is also more common in Hispanic, Asian, Native American, and Alaskan Native women.

What are the most effective treatments for lupus?
The cornerstone of treatment for lupus is hydroxychloroquine (Plaquenil) which has been used for over 60 years to reduce flare-ups and other symptoms. Corticosteroids are also used to manage symptoms and reduce inflammation. Immunosuppressant medications such as methotrexate, azathioprine, mycophenolate, cyclophosphamide, and rituximab are used in more severe cases of lupus to suppress the immune system.

In 2011 the first targeted therapy for lupus was made available that focuses on the specific parts of the immune system that cause lupus. Belimumab (Benlysta), a monoclonal antibody, is approved by the FDA to treat lupus in people 5 years of age and older, including those with kidney damage. It is given as an injection into a vein. For adults, it also may be given as an injection into the skin that allows the medication to be used at home. Another injectable monoclonal antibody medication, anifrolumab-fnia (Saphnelo), was approved recently and is given as an injection into a vein. Both medications may be used with other lupus medications to decrease the lupus disease activity caused by your immune system.

What else can I do to help with lupus symptoms?
In addition to taking or receiving the medications your doctor has prescribed, other actions will also help you manage lupus.

  • Take your medications as prescribed.
  • Adopt a healthy lifestyle – get enough sleep, eat healthy foods, and don’t smoke
  • Limit your time in the sun. Wear protective clothing and use sunscreen with an SPF of at least 30 when you are outdoors.
  • Be aware of when and what causes you to have “flares” or a sudden increase in symptoms.
  • Keep current with your immunizations including a yearly flu shot and the pneumonia vaccine if appropriate.
  • Because you need to avoid the sun, you may need to take a vitamin D supplement. Ask your pharmacist to select the appropriate dose.

I’m having trouble getting and affording my medication. What can I do?
Many of the injectable medications used for management of lupus are very expensive and your insurance company may require prior authorization from your doctor for to pay for the drug. In addition, you many have significant co-pays that your insurance does not cover. For some medications, you or a caregiver can give injectable drugs at home (instead of going to your doctor or a clinic), but that will require special training.

Does this all sound complicated? Ask your pharmacist! They are the medication experts and can answer your questions.

You may benefit from using a specialty pharmacy. Specialty pharmacies can help you to navigate getting the drug, working with your insurance company, or getting financial assistance to get the maximum coverage for payment. They will also make sure you understand how to use or take the medication and the importance of taking or using it regularly. They also can work with your doctor to make sure you are getting lab tests to check your response to the drug or any other required monitoring. Specialty pharmacists are also available to answer any questions you may have about your medication or side effects. In many cases specialty pharmacies can ship the medication right to your home or the setting that your will receive your treatment. This not only makes it easier and more affordable, but also to give you support to use your medications correctly.

Summary
Medications and other treatments for the management of lupus are important to controlling your disease and maintaining your quality of life. Be sure to ask your pharmacist or specialty pharmacist for help to receive the maximum benefit from your medications to improve your condition.

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