For the first time in more than 50 years, the FDA has approved a new drug for treating lupus. It’s an important breakthrough because the drug, belimumab (Benlysta), may help reduce lupus flare-ups and could lead to more effective treatments. New treatments are needed because lupus is a systemic autoimmune disease that can affect virtually every part of the body, making it tough to treat.
Good news: It used to be that most patients with systemic lupus erythematosus (SLE), the most common form of lupus, typically had symptoms for three to four years before getting an accurate diagnosis—but today, the delay has been reduced to about two to three years. This is a significant improvement, but it’s not ideal because the disease is chronic. Patients can develop irreversible organ damage if they don’t get treated.
Important: Patients often think that a lupus diagnosis is a death sentence. This is not true. Between 80% and 90% of lupus patients have a normal life expectancy. With better treatments—and earlier diagnosis—an even larger percentage will go on to have normal lives.
About one in every 1,000 Americans has been diagnosed with SLE. For unknown reasons, women are disproportionately affected. About half of SLE patients have a mild form of the disease that mainly affects the joints and skin. The other half have a more serious form that affects the organs, including the heart and kidneys.
The challenge: SLE presents itself in a number of ways. One patient might have a skin rash but no joint pain. Someone else might have joint pain and fatigue but no rash. Others might have signs of kidney or heart disease. The disease is also episodic. Most patients will experience intermittent flare-ups, during which the disease is active…then, they’ll have periods of quiescence, during which the disease is quiet, with no or only mild symptoms. Main tests…
Antinuclear antibody (ANA). This blood test detects antibodies that indicate an immune response against one’s self (autoimmune). More than 95% of SLE patients will have a positive ANA test. However, a positive result can also be caused by other autoimmune diseases, such as autoimmune thyroid disease or rheumatoid arthritis…an infection…certain medications (including some anticonvulsant medications)…or having a family history of lupus even in someone who doesn’t have the disease.
Anti-dsDNA antibody. This blood test is often used to confirm a diagnosis of SLE in someone who has a positive ANA test or who has symptoms that indicate lupus.
Other blood tests, including an erythrocyte sedimentation rate, can indicate abnormalities that are associated with lupus.
There isn’t a cure for SLE, but most patients can significantly reduce flare-ups, disease activity and subsequent complications with a combination of medications and preventive care…
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) and naproxen (Aleve) reduce joint pain and inflammation throughout the body in people with milder forms of SLE.
Hydroxychloroquine (Plaquenil). Originally used to treat malaria, it also reduces inflammation caused by SLE. Studies have shown that most lupus patients who take hydroxychloroquine have a reduction of symptoms. It also can help reduce the severity/frequency of flare-ups.
Some patients may experience side effects such as headache or an upset stomach. Regular eye exams are also recommended—in rare cases, long-term use of the drug can lead to retinal damage.
Immune-suppressing medications, such as methotrexate (Rheumatrex, Trexall) and azathioprine (Imuran), may be used for more severe cases of SLE. Steroids are potent anti-inflammatories and are frequently used to treat SLE—in low doses for milder manifestations such as arthritis and in high doses for severe features such as kidney inflammation (lupus nephritis). Other immunosuppressors, including mycophenolate (CellCept) or cyclophosphamide (Cytoxan), also are mainstays of treatment for lupus nephritis.
Benlysta is the first biologic medication that was designed specifically to treat SLE. It blocks the activity of B-lymphocyte stimulator, a protein that increases the production of antibodies and SLE.
Important: This medication is an important advance, but it’s effective in less than 50% of patients—and it has not yet been studied in such conditions as lupus nephritis.
Benlysta is given in a doctor’s office/medical center by IV infusion. The first three doses are given two weeks apart…then, the infusions are given monthly, although the schedule may be different for some patients. Common side effects include nausea, diarrhea and fever.
Every patient with SLE has triggers that increase the risk for flare-ups or worsen symptoms. Helpful…
Avoid the sun. Exposure to UV radiation from sunshine is among the most common triggers. Patients with SLE are advised to use aggressive sun protection that includes a UVA- and UVB-protective sunscreen with an SPF of 50 or higher.
Protect yourself from infection. Wash your hands several times a day…avoid contact with people with viral/bacterial infections…and get all recommended vaccinations. Viral and bacterial infections activate the immune system and can trigger a flare-up. If you get an infection: Ask your doctor if it’s safe to take sulfa antibiotics (such as Bactrim or Septra). Some patients with SLE are more likely to get a flare-up when they take these medications.
Eat well and emphasize fish. The same diet that’s good for the heart (high in complex carbohydrates, low in saturated fat) is good for lupus. Including several fish meals a week or a daily fish oil supplement is also helpful—there’s some evidence that the omega-3 fatty acids in fish can help lower inflammation and reduce disease activity.
