What medical treatments are available for lupus?

The diagnosis of lupus marks the beginning of management that does not necessarily aim for a complete cure, but rather for remission, meaning the control of inflammation to prevent irreversible damage. Lupus management must be a personalized approach, adjusted according to the severity of organ involvement and the patient’s profile (age, pregnancy, other existing diseases, etc.). It ranges from basic monitoring combined with the prescription of antimalarial drugs for mild cases, to intensive protocols that include immunosuppressive or biologic therapies for severe situations. Each strategy seeks to maintain the balance of the immune system, prevent flares, and reduce the development of complications.

The current range of available medical treatments now makes it possible to offer an almost normal life to most patients with lupus, provided that they adhere strictly to their prescribed therapy.

Once the diagnosis has been made, the main goal becomes clear: to calm the inflammation immediately and restore a certain balance within the immune system. This is when the first level of treatment for lupus is introduced, which is generally effective in managing mild to moderate forms. These treatments also play an essential long-term role: they help reduce the frequency of flare-ups, and also limit their severity when they occur.

Synthetic antimalarial drugs as first-line treatment in lupus.

In clinical practice, hydroxychloroquine is recommended in nearly all cases. It forms the backbone of long-term therapy for most patients. It offers multiple benefits, including reducing the frequency of flares and protecting organs over the long term. Its mechanism is based on modulation of the immune system: it inhibits certain lysosomal enzymes, limits lymphocyte activation, and reduces both the production of autoantibodies and the stimulation of Toll-like receptors, which drive inflammation. This treatment is generally well tolerated, even during pregnancy, but there are some contraindications, particularly in the presence of severe kidney disease, significant liver impairment, preexisting cardiac disorders, or hypersensitivity to the drug.

According to a meta-analysis, prolonged use of hydroxychloroquine could reduce the risk of mortality in lupus patients by approximately 50%. In addition, beyond its ability to enhance immune function, it also has a beneficial effect on lipid profiles and reduces the risk of thrombosis.

However, long-term use requires regular monitoring. Hydroxychloroquine tends to slowly accumulate in certain cells of the eye, particularly in the retina. Over time, this buildup can interfere with the function of the cells responsible for capturing light (photoreceptors), as well as the supporting cells, leading to a rare but serious retinopathy. An electrocardiogram may also be recommended for patients with cardiac rhythm disorders, since hydroxychloroquine can, in rare cases, slow electrical conduction in the ventricles, promoting arrhythmias that are sometimes mild but can be more serious. Precautions are also necessary to avoid drug interactions, particularly with certain antiarrhythmics, digoxin, or medications that alter heart rhythm. The usual adult dosage is 200 to 400 mg per day, adjusted according to the patient’s weight and tolerance.

Nonsteroidal anti-inflammatory drugs (NSAIDs) for mild forms of lupus.

For less severe symptoms, such as joint pain or a mild fever, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may be prescribed. These medications act rapidly by inhibiting cyclooxygenase enzymes (COX-1 and COX-2), which reduces the production of prostaglandins responsible for inflammation, pain, and fever, without hormonal effects or any direct action on the immune system. However, they must be used with caution. The main contraindications include kidney failure, gastritis or an active ulcer, a history of bleeding disorders, certain cardiovascular and neurological conditions, as well as hypersensitivity to NSAIDs.

During the third trimester of pregnancy, certain NSAIDs are also not recommended.

Precautions for use are necessary: monitor kidney and liver function, avoid combining them with anticoagulants or high-dose corticosteroids, and limit their use to short, intermittent periods. The usual dosage for ibuprofen is 200 to 400 mg every six to eight hours, while naproxen is generally prescribed at 250 to 500 mg twice a day, always adjusted according to the patient’s tolerance and body weight. Adverse effects may include digestive disorders (stomach pain, ulcers, bleeding), long-term kidney toxicity, increased blood pressure, skin reactions, or disturbances in blood clotting.

Clinical research has shown that prolonged use of NSAIDs in patients with lupus can also mask the onset of nephritis, which requires careful medical monitoring.

Corticosteroid therapy for lupus.

When health status worsens, corticosteroids are used to rapidly control inflammatory flare-ups, often with a striking impact on symptoms. The prescribed doses vary according to the type and severity of the condition, and once symptoms are controlled, the dose is gradually reduced to limit side effects. In cases of severe flare or when a very rapid effect is needed, corticosteroids can be given by intravenous infusion. However, this effectiveness is accompanied by significant side effects. Prolonged use can lead to weight gain in about 30 to 50% of patients, a risk of diabetes in 10 to 20%, and high blood pressure in up to 20 to 30%. The immunosuppressive effect also increases the risk of infections, and comorbidities may accumulate, such as cataracts or metabolic disorders.

In children, particular caution is even more important in order not to interfere with growth. Cortisone is also a common cause of osteoporosis. It is estimated thatapproximately 30 to 50% of patients exposed over the long term develop bone fragility, with a real risk of fractures. The therapeutic goal remains to find the lowest effective dose (often < 7.5 mg/day) and to gradually taper it down as soon as this is feasible. Clinical studies show that continuous administration of high-dose corticosteroids, generally above 20 mg/day of prednisone or equivalent for several months to several years, is the main factor responsible for cumulative organ damage over a decade. Current protocols therefore favor high-dose administration over a short period (bolus), followed by a rapid taper in order to preserve the patient’s metabolism.

When the disease worsens or affects vital organs (kidneys, heart, and brain), it becomes necessary to use agents capable of further suppressing the immune system.

Immunosuppressive therapies in cases of severe or treatment‑resistant organ involvement in lupus.

For moderate to severe forms of lupus, immunosuppressants such as azathioprine, methotrexate, or mycophenolate mofetil may be prescribed. Their role is to calm the immune system by reducing the activity of the cells responsible for inflammation: they slow the proliferation of T and B lymphocytes, decrease the production of pro-inflammatory substances, and interfere with immune activation mechanisms.

Their main advantage is that they make it possible to reduce, or even stop, cortisone treatment, which helps limit its side effects. However, they require strict medical monitoring, including regular blood tests, because in approximately 10 to 30% of cases, they can lower the blood level of white blood cells. Some of them, such as methotrexate, mycophenolate mofetil, and cyclophosphamide, are strictly contraindicated during pregnancy due to the risk of congenital malformations.

In contrast, the use of mycophenolate mofetil has revolutionized the prognosis of lupus nephritis. A comparative study evaluated the effectiveness of immunosuppressive agents in lupus, particularly in lupus nephritis. Several randomized trials and meta-analyses show that mycophenolate mofetil is at least as effective as cyclophosphamide in inducing renal remission, and in some cases tends to be associated with better outcomes.

Biologic therapies in the treatment of lupus.

Biotherapies (monoclonal antibodies) have represented a major advance in the management of lupus in recent years. Unlike conventional drugs, they precisely target specific mechanisms of the immune system. Belimumab, administered subcutaneously (typically as a weekly injection), works by blocking a key protein, BAFF (B-cell Activating Factor), which is required for the survival of B lymphocytes involved in the disease. By preventing this protein from binding to its receptors, it deprives these cells of survival signals, leading to a gradual reduction in the most abnormal B lymphocytes. More recent agents, such as anifrolumab, given as a monthly intravenous infusion, target even more specific pathways, particularly type I interferons, which play a major role in lupus-related inflammation.

The results of the phase III TULIP clinical trials are particularly promising. They show that biologic therapies do not simply reduce overall disease activity, as measured for example by the SLEDAI index, but also provide tangible improvements in daily life. A large number of patients experience a significant reduction in persistent skin damage and relief from chronic joint pain. In a very large Italian observational study including 443 patients with lupus treated with belimumab, a significant reduction in the activity of joint and skin manifestations was observed, along with high remission rates in certain clinical forms—for example, up to approximately 76% cutaneous remission in some subgroups at 18 months.

These treatments are generally proposed when the disease remains active despite conventional therapies. They help reduce the overall activity of lupus, improve persistent symptoms, and decrease dependence on corticosteroids. However, their use requires certain precautions: they are contraindicated in cases of active infection and must be used with caution in immunocompromised patients. Updating the vaccination status is often recommended before starting these therapies, and regular monitoring is essential. The most common adverse effects include reactions at the injection site or during infusions, headaches, fatigue, or an increased risk of infections, particularly viral infections (such as shingles with anifrolumab). More rarely, hypersensitivity reactions may occur.

Lupus in children requires special attention. In this age group, the disease is often more active, which makes management more complex. This intensity is explained by a combination of factors. Children’s immune systems tend to react more strongly, and kidney and neurological involvement appears earlier and in a more severe form. The goal is to control inflammation without impairing growth or disrupting puberty. Thus, the treatment of juvenile lupus aims to limit long-term corticosteroid use as much as possible, favoring so‑called “steroid‑sparing” therapies. This strategy helps to keep the disease under control while reducing long-term side effects. Among these treatments, hydroxychloroquine is often prescribed to reduce the frequency of flares, with regular ophthalmologic monitoring, while certain immunosuppressants, such as azathioprine or mycophenolate, may be used in severe cases, with strict adherence to dosing and avoidance of certain drugs such as methotrexate during the first trimester of any future pregnancy. For treatment‑resistant forms, some biologic therapies, such as belimumab from age 5 onward, may be considered under close medical supervision.

However, treatment is not limited to medication. Preventive measures are also essential: full sun protection, up-to-date vaccinations, and psychological support. This last aspect is often underestimated, yet it is critically important. It helps the child cope better with the disease, particularly with the physical changes related to treatment, such as facial swelling. Several clinical studies indicate that early use of immunosuppressants, such as azathioprine, can reduce exposure to corticosteroids by about 40%. Over the long term, this helps preserve metabolic health in adulthood and bone mineral density during the critical growth period.

Beyond first- and second-line treatments, the management of lupus also involves another essential dimension: supportive care. Although these measures are not intended to directly halt the immune system’s attack, they nonetheless serve several key functions, including protecting organs from collateral damage, reducing the side effects of intensive therapies, and helping to maintain a stable day-to-day quality of life.

Lupus and topical use of botanical extracts.

Topical treatments are most often the first line of defense against the cutaneous symptoms of discoid lupus. Topical corticosteroids act by binding to specific nuclear receptors and inhibiting the production of pro‑inflammatory mediators, thereby reducing tissue damage without entering the systemic circulation. One study suggests that the use of high‑potency topical corticosteroids leads to a complete resolution of skin lesions in approximately 50% of patients with discoid lupus erythematosus. However, prolonged use may cause skin atrophy.

The intake of evening primrose or borage seed oils, which are rich in gamma-linolenic acid (GLA), can help restore the lipid barrier, which is often impaired. In addition, true lavender essential oil or Boswellia carterii exhibits soothing properties and inhibitory effects on the enzyme 5‑lipoxygenase, which converts arachidonic acid into leukotrienes. These molecules act as powerful alarm signals that trigger swelling, redness, and the influx of immune cells into the skin. This helps calm skin irritation and reduce tissue damage around lupus lesions. Furthermore, studies on Boswellia extracts confirm their notable anti-inflammatory potential, suggesting that these botanical preparations could help reduce the excessive use of topical steroids.

Although these treatments improve aesthetic appearance and skin comfort, they do not address the underlying immune cause. They can be used as an adjunct, without replacing medical treatments.

Dietary supplements for lupus.

In the management of lupus, certain dietary supplements can provide beneficial support. They are always taken in addition to medical treatment, and their effectiveness depends largely on consistent use. Vitamin D plays a central role. Its functions go beyond its ability to protect bones, which are weakened in patients receiving corticosteroid therapy. It also helps modulate the immune system. This is why a daily supplementation of 800 to 2,000 IU, depending on individual needs, is recommended. Omega‑3 fatty acids, found mainly in fish oils, are also of interest. They act on both inflammation and the health of the heart and blood vessels, which is a key issue in lupus. Taken at a dose of about 2 to 3 g per day, they may help reduce joint pain and improve blood vessel function.

Certain plants are sometimes mentioned for their anti-inflammatory properties. For example, turmeric (Curcuma longa) contains curcumin, a compound that acts on mechanisms similar to those targeted by certain medications. Its effect, however, remains moderate and primarily preventive. A study points out that while some plants can provide long-term support and may potentially help reduce corticosteroid use, they are not sufficient to manage an acute flare.

Although some supplements more or less support the management of lupus, certain plant species should be avoided. Alfalfa, for example, contains a substance that can overstimulate the immune system and trigger or worsen a flare.

• OSTENSEN M. & al. Nonsteroidal anti-inflammatory drugs in systemic lupus erythematosus. Lupus (2000).

• HUGHES G. R. V. & al. Mycophenolate mofetil for systemic lupus erythematosus refractory to other immunosuppressive agents. Rheumatology (2002).

• STICHERLING M. & al. Update on the use of tropical calcineurin inhibitors in cutaneous lupus erythematosus. Biologics: Targets and Therapy ISSN (2011).

• RAYMOND A. A. The clinical significance of vitamin D in systemic lupus erythematosus: A systematic review. Plos One (2013).

• BOUMPAS D. T. & al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Annals of the Rheumatic Diseases (2019).

• CERVERA R. & al. Systemic lupus erythematosus and hypertension. Autoimmunity Reviews (2019).

• BRUNNER H. I. & al. Glucocorticoids pharmacology and their application in the treatment of childhood-onset systemic lupus erythematosus. Seminars in Arthritis and Rheumatism (2020).

• RUIZ-IRASTORZA G. Glucocorticoids in systemic lupus erythematosus. Ten questions and some issues. Journal of Clinical Medicine (2020).

• TUMMALA R. & al. Trial of anifrolumab in active systemic lupus erythematosus. New England Journal of Medicine (2020).

• SCHLESINGER N. & al. & al. The effect of Omega-3 fatty acid supplementation in systemic lupus erythematosus patients : A systematic review. Lupus (2022).

• SOEMYARSO N. A. & al. Drug utilization study of corticosteroid sparing agent in pediatric patient with lupus nephritis (Study at department of Dr. Soetomo teaching hospital, Surabaya). Journal Ilmiah Indonesia (2022).

• ZHANG Z. & al. Comparison of the effectiveness and safety of mycophenolate mofetil and cyclophosphamide in lupus nephritis: Evidence from a real-world study. Rheumatology and Therapy (2023).

• LACCARINO, L. & al. Efficacy of Belimumab on different joint and skin manifestations of systemic lupus erythematosus: Real-life data from a new multicentric, nationwide italian cohort (BeRLiSS-JS 2.0). Biologics (2025).

• MOHAMMADI K. & al. The effects of curcumin supplementation on inflammatory markers in systemic lupus erythematosus patients: a randomized placebo-controlled trial. European Journal of Nutrition (2025).

• VAN DER FELS-KLERX H. J. & al. A review of the toxicological effects and allergenic potential of emerging alternative protein sources. Food Science and Food Safety (2025).