Treatment

There's currently no cure for systemic lupus erythematosus (SLE), but treatments can ease the symptoms and make it easier to live with.

In most cases, treatment involves a combination oflifestyle measures and medication.

Protecting yourself from the sun

Exposure to sunlight can sometimes make symptoms such as rashes worse, and it'simportant to protect your skin whenin the sun.

This means wearing:

• clothing that covers your skin
• a wide-brimmed hat
• sunglasses

You'll also need to apply sunscreen with a high SPF to prevent sunburn. However, some people with lupusaren't sun-sensitive and don't need to take extra precautions.

Read about sunscreen and sun safety

Vitamin D

As people get most of their vitamin D as a result ofdirect sunlight onthe skin, there's a risk youmay not get enough of this vitamin if you need to avoid sun exposure.

This means you may need to make an extra effort to include good sources of vitamin D in your diet to avoid problems such as Osteoporosis (weakened bones), and you may be advised to take vitamin D supplements.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) are common painkillers that reduce inflammation in the body. If you experience joint or muscle pain as a result of SLE, you may be prescribed an NSAID to help ease your symptoms.

Commonly prescribed NSAIDs for SLE include:

• ibuprofen
• naproxen
• diclofenac

You can buy some NSAIDs, such as ibuprofen, over the counter. These NSAIDs may be suitable if your joint or muscle pain is mild. For more severe pain, you'll need stronger medication prescribed by your GP.

NSAIDs may not be suitable for people who have stomach, kidney or liver problems, or have had these problems in the past. They may also be unsuitable for people with asthma. Your GP will adviseabout which NSAID is rightfor you.

Side effects

If taken in high doses or over long periods of time, NSAIDs can damage your stomach lining, which may cause internal bleeding.

If you need to take NSAIDs on a long-term basis, your GP will carefully monitor you to check for any problems, and you may be prescribed an additional medication called a proton pump inhibitor (PPI) to protect your stomach.

Hydroxychloroquine

Hydroxychloroquineis a medicinethat's beenused to treat malaria , butis also effective in treating some of the symptoms of SLE, such as rashes, joint and muscle pain, and fatigue.

You'll usually have to take hydroxychloroquine for 6 to 12 weeks before younotice any benefit.

Most expert doctors recommendpeople with SLE take hydroxychloroquine on a long-term basis to:

• control their symptoms
• help prevent flare-ups
• prevent the development of more serious problems from lupus

Side effects

Side effects of hydroxychloroquine are uncommon, but may include:

• indigestion
• diarrhoea
• headaches
• rashes

Hydroxychloroquine may also cause more serious side effects in a small number of people. For example, in rare cases, this medicine can causeeye damage.

Contact your GP or specialist immediately if you experience vision problems while taking hydroxychloroquine.

If your GP or specialist feels it's necessary, you may need regular eye examinations.

Corticosteroids

Corticosteroids area type of medicine that help reduce inflammation quickly. They can be very effective in treating symptoms of SLE, but are usually only prescribed if the condition is severe.

If you have severe symptoms of SLE, or if you're experiencing a flare-up, you may be given a large dose of corticosteroids to help bring your symptoms under control. As your symptoms ease, your dosage can gradually be reduced.

Side effects

When prescribing corticosteroids, the lowest effective dosage is always given. This is because high doses or long-term use of corticosteroids can cause side effects. These may include:

• thinning of your bones
• thinning of your skin
• weight gain
• high blood pressure (hypertension)
• high blood sugar

Corticosteroids are a safe and effective form of treatment, as long as they're taken correctly and under the supervision of your GP or specialist. They'll tailor the steroid dose to minimise side effects while effectively controlling the condition.

Immunosuppressants

Immunosuppressants are a type of medicine that suppress your immune system. They can help improve your symptoms of SLE by limiting the damageyour immune system causes when it attacks healthy parts of your body.

Commonly prescribed immunosuppressant medicines include:

• azathioprine
• methotrexate
• mycophenolate mofetil
• cyclophosphamide

Immunosuppressants are sometimes used alongside corticosteroids because these medicines may ease your symptoms more effectively when used together.

Alternatively, the use of immunosuppressant medication may allow your corticosteroid dose to be reduced.

Side effects

Immunosuppressant medication is usually only prescribed if you have severe SLE. This is because this type of medication is powerful and can cause side effects, such as:

• loss of appetite
• vomiting
• diarrhoea
• swollen gums
• low blood count
• bruising or bleeding more easily
• headache
• acne
• extra hair growth
• weight gain
• liver damage
• an increased risk of infection (see below)

Methotrexate, mycophenolate mofetil and cyclophosphamide can also cause birth defects if they're taken during pregnancy.

You should use a reliable form of contraception if you're taking these medications and are sexually active. If you're trying to become pregnant, an alternative medication such as azathioprine can be used.

Tell your GP if a side effect becomes particularly troublesome, asit may mean your dose needs to be adjusted.

Infection risk

Taking immunosuppressant medication can increase your risk of developing an infection. This is a particularly seriousconcern for people with SLE, because the organ damage that can occur as a resultof the condition means infections are more likely to be life-threatening.

It's very important to report anysymptoms of a possible infection to your GP immediately.

Symptoms of infection may sometimes be similar to a flare up ofSLE and include:

• a fever (high temperature)
• a cough or breathlessness
• burning when passing urine or passing blood inyour urine
• diarrhoea

You should also try to avoid contact with anyone known to have an infection even if it's an infection you were previously immune to, such as chickenpox or measles .This is because your previous immunity to these conditions will probably be suppressed (lowered).

You should receive a seasonal flu jab and pneumococcal vaccination on a regular basis.

Rituximab

Rituximabis a new type of medicationused in people with severe SLEthatdoesn't respond to other treatments.

Rituximab was originally designed to treat certain types of cancer, such as lymphoma, but it's since proved effective in treating a number of autoimmune conditions, such as SLE and rheumatoid arthritis .

Rituximab works by locking on to and killing immune system cells called "B-cells", which produce antibodies responsible for the symptoms of SLE. It's administered directly into your vein over the course of several hours, known as an infusion.

Your specialist may consider rituximab an appropriate treatment for you. If your doctor suggests using rituximab, they should tell you that there are currently some uncertainties about how effective it is in treating SLE.

Side effects

Common side effects of rituximab include:

• flu -like symptoms, such as chills and a high temperature
• dizziness
• vomiting

In rare cases, rituximab can cause a more serious allergy-like reaction. Most reactions occur during or shortly after the treatment is given, so you'll be closely monitored once your treatment begins.

Belimumab

Belimumab is a new medication given to people with active SLE who don't respond to other treatments.

Itworks by binding to growth factors that are needed for the survival of B-cells. It's given directly into your vein over several hours, known as an infusion. The first three doses are given 14 days apart, andthe medication is usually given once a month thereafter.

Belimumab is licensed for treating SLE in the UK and there may be instances where your specialist may consider it an appropriate treatment for you. If your doctor suggests using belimumab, they should tell you that there are currently some uncertainties about how effective or safe it is in treating SLE.

Side effects

Common side effects of belimumab include:

• flu-like symptoms, such as chills and a high temperature
• nausea and diarrhoea
• headache
• difficulty sleeping ( insomnia )
• a cough, sore throat and blocked or runny nose
• joint pain
• increased risk of infections
• changes in blood pressure

In rare cases, belimumab can cause a more serious allergy-like reaction. Most reactions occur during or shortly after the treatment is given, so you'll be closely monitored once your treatment begins.