Treatment of lupus depends on flare-up experienced
Management of lupus usually depends on disease manifestations and disease severity. However, hydroxychloroquine is mainly used for long-term treatment of lupus. The LUMINA and other studies have shown that there is a decrease of flares and also a prolonged life in patients that gave hydroxychloroquine.
Generally, serositis, musculoskeletal manifestations and cutaneous manifestations represent milder disease. These mild diseases can be controlled with NSAIDS drugs or low-potency immunosuppression medications and/or some corticosteroids. When the disease attack vital organs, then it requires more prolonged steroid use. Some of the severe manifestations include diffuse proliferative renal disease and central nervous system manifestation. These severe manifestations usually require an aggressive immunosuppression.
Evidence suggest an under treatment of lupus patients with ESRD since the extent of lupus activity seems to be underestimated.
In 2007, EULAR gave out the recommendations for treatment of lupus. Patients with lupus without antimalarial agents, glucocorticoids and major organ manifestations maybe beneficial. The NSAIDS drugs may be used for those patients with low risk for complications, although for short periods.
Immunosuppressive agents such as mycophenolate, methotrexate, mofetil and azathioprine should be considered when steroid doses cannot be reduced to the required level or for refractory cases.
EULAR recommends treatment of neuropsychiatric manifestations in the same way as those without lupus. The evaluation and treatment are the same, but if the symptoms persist, then management of the symptoms should be considered as an extension of lupus. For instance, if the patient has neuropsychiatric manifestations which may have inflammatory etiology, then immunosuppressive agents should be considered.
It is worth noting that there has been continued improvement in the diagnosis and treatment of lupus. In 1950s, the survival rate for lupus patients was at 5% but nowadays 95% of patient with lupus have 5-year survival rate.
It is also worth noting that most lupus patients have a mild form. With proper medication, those with severe lupus can control the flare-up and live good productive lives.