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Systemic Lupus Erythematosus: Treatment, Procedure, Cost and Side Effects

What is the treatment? How is the treatment done? Who is eligible for the treatment? (When is the treatment done?) Who is not eligible for the treatment? Are there any side effects? What are the post-treatment guidelines? How long does it take to recover? What is the price of the treatment in India? Are the results of the treatment permanent? What are the alternatives to the treatment?

What is the treatment?

Systemic Lupus Erythematosus is a chronic inflammatory autoimmune disease caused when the immune system attacks its own tissues because it confuses it for something foreign. Lupus (SLE) can affect various parts of the body like the joints, skin, kidneys, blood cells, brain, heart and lungs. Systemic Lupus Erythematosus is characterized by the production of unusual antibodies in the blood.

Symptoms vary from person to person and these can periodically get worse that is flare up and then again improve. Some of the most common symptoms of lupus include painful or swollen joints (arthritis), unexplained periodic fever, and extreme fatigue. A characteristic red skin rash which is called the butterfly or malar rash may appear across the nose and cheeks of the patient. Rashes may also occur on the other parts of the face and ears, upper arms, shoulders, chest, and hands. Many people with lupus are sensitive to sunlight (called photosensitivity) and thus the skin rashes often first develop or worsen after exposure to the sun. People may also show signs of chest pain upon deep breathing, unusual loss of hair, swelling (oedema) in legs or around eyes, mouth ulcers etc. A phenomenon called the Raynaud's phenomenon may occur in some people where the fingers or toes become pale and purple from cold or stress.

While there's no cure for lupus, current treatments of SLE focus on improving the quality of life through controlling symptoms and minimising flare-ups. The treatments depend on how severe the symptoms are, whether the organs are affected because of it and how much the symptoms are affecting everyday life. For mild symptoms, the treatment mainly addresses to cure the flare ups and joint pains, lower fatigue and prevent the occurrence of rashes on the skin. Avoiding the sun is very important as exposure to sun rays enhance rashes on the skin. Use of sunscreens, covering the exposed portions etc can prevent direct hitting by the sunrays. Creams and drugs are also prescribed by the doctor to cure the flare ups and provide relief to the patient. For severe symptoms of lupus, the Corticosteroids are taken in higher dosage. Also, medicines which suppresses the immune system called immunosuppressants can be taken.

How is the treatment done?

In order to diagnose systemic lupus erythematosus and its severity, dermatologists or rheumatologists may prescribe physical examinations. Those exams include blood tests, such as antibody tests and a complete blood count, a urinalysis and a chest X-ray. These tests help to understand the extent of sensitivity to sun, extent of joint pain, fatigue, hair loss, hair thinning et cetera.

There is no cure to this disease, treatment can only help to lessen the symptoms and ease the pain. Treatment begins with lifestyle modifications, including sun protection and diet. Further disease management includes medication such as anti-inflammatories and steroids depending on the type of symptoms and the severity. Medications include Non-steroidal anti-inflammatory drugs, Antimalarial drugs, Corticosteroids and immune suppressants and biologics. Non steroidal anti-inflammatory drugs or NSAIDs include drugs like ibuprofen and naproxen that help to decrease joint swelling, joint pain, fever, and inflammation of the heart and lung linings. Every patient with lupus is given the antimalarial drug called Hydroxychloroquine (Plaquenil) that helps lessen arthritis, fatigue, rashes, and mouth sores. Patients with serious or life-threatening problems of lupus such as kidney inflammation, lung or heart involvement, and central nervous system symptoms need corticosteroids and immune suppressants. These drugs are stronger than the earlier ones that suppress the immune system and include azathioprine (Imuran), cyclophosphamide (Cytoxan), and cyclosporine (Neoral, Sandimmune) et cetera. Belimumab (Benlysta), a type of biomedic can be used for the treatment of active mild SLE in adult patients.

Apart from the medical treatment, treatment also includes maintaining a proper diet, protecting as much from sun rays and definite self care.

Who is eligible for the treatment? (When is the treatment done?)

A person must immediately consult a doctor when symptoms of systemic lupus erythematosus show up. People with symptoms of a heart attack like chest pain, shortness of breath, nausea or vomiting along with numbness, tingling, or weakness, fever etc call for doctor’s attention. Person with symptoms of rashes, fever, joint pain are eligible for the treatment of lupus.

Who is not eligible for the treatment?

Symptoms of systemic lupus erythematosus occur periodically. They keep occurring and disappearing only to flare up after a while. If the symptoms have occurred just once and do not follow a periodic pattern, then the person may not need any treatment. One time occurrence may be due to some allergic reactions or infection and does not call for medical assistance of lupus.

Are there any side effects?

Treatment of SLE and its medicines have an adverse effect on the body if used for a long time or taken in high doses. Medicines for lupus like NSAIDs can cause serious side effects like stomach bleeding or kidney damage. Side effects for antimalarial drugs can include stomach upset and, very rarely, damage to the retina of the eye. Corticosteroids, if used over a long period of time can cause side effects which include weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection. Immunosuppressants are known to cause liver damage, decreased fertility and an increased risk of cancer. Other possible side effects include nausea, diarrhea, allergy and depression.

What are the post-treatment guidelines?

After the treatment, it is very important for each individual to take immense self care. Medicines and routine check ups must be followed as prescribed by the doctor. It is very vital to protect oneself from the sun rays. Wearing clothes with maximum coverage, sunglasses and masks can prevent the relapse of rashes and additional symptoms of SLE. Maintaining a healthy diet and taking adequate rests and doing exercises properly are some of the vitals each patient must take care of.

How long does it take to recover?

Systemic lupus erythematosus is a disease that keeps recurring and is known to have no cure till yet. However, medicines are available that help to remove the flare ups and prevent them from recurring. Also, medicines which help to treat joint pain, chest pain et cetera are used over a period and SLE is brought under control. There is no definitive time period as treatment depends on the type and severity of the disease. Severe life-threatening ones require a longer time for treatment, sometimes with surgeries while mild ones can be cured by taking medicines for the required time span.

What is the price of the treatment in India?

Treatment of lupus is a cost incurring procedure. It approximately ranges between Rs. 2,00,000/- to Rs. 10,00,000/- .

Are the results of the treatment permanent?

Systemic lupus erythematosus is a chronic autoimmune disease and is known to have no permanent cure. This disease can only be treated so lower the pain in the joints, chest and other parts and also to lessen the rashes or flare ups on the skin.

What are the alternatives to the treatment?

Alternative treatments also include medicines and therapies which aim at keeping the disease from progressing. These alternative treatments include stem cell transplantation and biologic treatment. Also, home remedies can help cope up with lupus. Learning stress management, getting enough rest and proper skin care can help to prevent worsening of the condition.

Popular Questions & Answers

Dear Sir, I am aged-45, Female, Weight-29 kg, from Bangladesh. I am suffering from MCTD Disease from 1999. At present I am under supervision of two doctors: One doctor is from Kolkata India, Dr. Asim Kumar Pal, MD, FICA (USA), MRCP (UK), FRCP (Edin), FRCP (London). Peerless Hospital & B.K.Roy Research Center Kolkata India, Since 1999 every year 3 times, and another doctor is from Bangladesh Professor Dr. Syed Atiqul Haq MBBS, FRCP, FCPS, MD, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Since 2006 every year 3 times. I am taking medicine methotrexate weekly since 1999 but last two years I am not taking this medicine. I also take Nidipin SR. Apart from these two medicine. I take some other medicine for short period of time recommended by my doctors. I also took steroid (Prednisone) medicine for last 9 years but not regularly. I took this medicine once in every four/six month. As a side effect of this medicine my femoral head’s blood supply stops and doctor suggested me for surgery. I did this in Apollo hospitals, Delhi. In every three months I do some diagnostic test (TC, DC ESR, AST, SGOT, Urine R/A, Chest X ray PA view, etc ….)all the reports are normal. At Present my problem are: •I can’t eat anything normally. If I try to eat it cramp in my stomach and starts beating. •Fever at least ¾ time in every month. •Whole body pain.\ •I Can’t grip my hand. •I Can’t seat alone on the floor for last 5 years. •Gastro problem. •Always cough Can I have treatment in your hospital? I request your suggestion.

MMed, MBBS, DAA
Allergist/Immunologist, Chennai
no it seems like a rhumatological problem. you are in good hands. please follow the medications prescribed by yout doctors. also discuss with doctors if newer biologicals can be used.

RNP/sm intensity is 1, sm intensity is 1, RO-52 intensity us 17, SSB intensity is 1, PM-scl is 2, JO-1 intensity is 1, ds-DNA is 2, control CO is 88.

NCCH & MCH
Homeopath, Raebareli
Dear user kindly forward the reports and symptomatic details as of now for proper treatment and management support. For now take a dose of Rhus tox 30 it will act in the main disease itself but do not repeat further till analysis is done reviewing...

What is the meaning of ANA +ve. What is treatment available for it and how does it cost.

MBBS, MD - Internal Medicine
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ANA is a type of antibody test usually positive in auto immune disorders some types of arthritis, vasculitis etc. But the titre of the test makes it significant. It can be positive in low titres like 1: 40 or 1: 80 in the general population withou...

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