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Systemic Lupus Erythematosus is a chronic inflammatory disease that affects any organ system, including the musculoskeletal system. The cause of systemic lupus erythematosus is unknown. SLE is characterized by the formation of autoantibodies and immune complexes. Typically, SLE appears in people who have B-cell hyperreactivity. They also present with an increased production of antibodies against self and non-self antigens. The B cells produce different types of antibodies. These autoantibodies damage tissues or form tissue-damaging immune responses.

Reference: Norris, T. L. (2024). Porth's Pathophysiology (11th ed.). Wolters Kluwer Health.

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The current treatments for SLE are commonly used to treat inflammation and symptoms of lupus. The treatment depends on the manifestation that is present in each person. The treatment differs from patient to patient. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve some lupus symptoms. Antimalarial drugs such as Plaquenil can help decrease the risk of lupus flares. Corticosteroids are used to reduce inflammation. Immunosuppressants are used for severe cases of lupus. Some biologics can be administered to help relieve lupus symptoms.

Reference: Mayo Clinic. (21 October 2022). Lupus. https://www.mayoclinic.org/diseases-conditions/lupus/diagnosis-treatment/drc-20365790

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There are acute and long-term treatments for SLE. Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and antimalarial drugs are used to treat acute SLE symptoms. Immunosuppressants and biologics are long-term treatments used for SLE.

Reference: Mayo Clinic. (21 October 2022). Lupus. https://www.mayoclinic.org/diseases-conditions/lupus/diagnosis-treatment/drc-20365790

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Diagnosis

Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders.

No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis.

Laboratory tests

Blood and urine tests may include:

Complete blood count. This test measures the number of red blood cells, white blood cells and platelets as well as the amount of hemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur in lupus as well.

Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate isn't specific for any one disease. It may be elevated if you have lupus, an infection, another inflammatory condition or cancer.

Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs.

Urinalysis. An examination of a sample of your urine may show an increased protein level or red blood cells in the urine, which may occur if lupus has affected your kidneys.

Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies - produced by your immune system - indicates a stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA do not have lupus. If you test positive for ANA, your doctor may advise more-specific antibody testing.

Imaging tests

If your doctor suspects that lupus is affecting your lungs or heart, he or she may suggest:

Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs.

Echocardiogram. This test uses sound waves to produce real-time images of your beating heart. It can check for problems with your valves and other portions of your heart.

Biopsy

Lupus can harm your kidneys in many different ways, and treatments can vary, depending on the type of damage that occurs. In some cases, it's necessary to test a small sample of kidney tissue to determine what the best treatment might be. The sample can be obtained with a needle or through a small incision.

Skin biopsy is sometimes performed to confirm a diagnosis of lupus affecting the skin.

Treatment

Treatment for lupus depends on your signs and symptoms. Determining whether your signs and symptoms should be treated and what medications to use requires a careful discussion of the benefits and risks with your doctor.

As your signs and symptoms flare and subside, you and your doctor may find that you'll need to change medications or dosages. The medications most commonly used to control lupus include:

Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), may be used to treat pain, swelling and fever associated with lupus. Stronger NSAIDs are available by prescription. Side effects of NSAIDs include stomach bleeding, kidney problems and an increased risk of heart problems.

Antimalarial drugs. Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), affect the immune system and can help decrease the risk of lupus flares. Side effects can include stomach upset and, very rarely, damage to the retina of the eye. Regular eye exams are recommended when taking these medications.

Corticosteroids. Prednisone and other types of corticosteroids can counter the inflammation of lupus. High doses of steroids such as methylprednisolone (A-Methapred, Medrol) are often used to control serious disease that involves the kidneys and brain. Side effects include weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and longer term therapy.

Immunosuppressants. Drugs that suppress the immune system may be helpful in serious cases of lupus. Examples include azathioprine (Imuran, Azasan), mycophenolate mofetil (CellCept) and methotrexate (Trexall). Potential side effects may include an increased risk of infection, liver damage, decreased fertility and an increased risk of cancer.

Biologics. A different type of medication, belimumab (Benlysta) administered intravenously, also reduces lupus symptoms in some people. Side effects include nausea, diarrhea and infections. Rarely, worsening of depression can occur.

Rituximab (Rituxan) can be beneficial in cases of resistant lupus. Side effects include allergic reaction to the intravenous infusion and infections.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Take steps to care for your body if you have lupus. Simple measures can help you prevent lupus flares and, should they occur, better cope with the signs and symptoms you experience. Try to:

See your doctor regularly. Having regular checkups instead of only seeing your doctor when your symptoms worsen may help your doctor prevent flare-ups, and can be useful in addressing routine health concerns, such as stress, diet and exercise that can be helpful in preventing lupus complications.

Be sun smart. Because ultraviolet light can trigger a flare, wear protective clothing - such as a hat, long-sleeved shirt and long pants - and use sunscreens with a sun protection factor (SPF) of at least 55 every time you go outside.

Get regular exercise. Exercise can help keep your bones strong, reduce your risk of heart attack and promote general well-being.

Don't smoke. Smoking increases your risk of cardiovascular disease and can worsen the effects of lupus on your heart and blood vessels.

Eat a healthy diet. A healthy diet emphasizes fruits, vegetables and whole grains. Sometimes you may have dietary restrictions, especially if you have high blood pressure, kidney damage or gastrointestinal problems.

Ask your doctor if you need vitamin D and calcium supplements. There is some evidence to suggest that people with lupus may benefit from supplemental vitamin D. A 1,200- to 1,500-milligram calcium supplement taken daily may help keep your bones healthy.

Alternative medicine

Sometimes people with lupus seek alternative or complementary medicine. However, there aren't any alternative therapies that have been shown to alter the course of lupus, although some may help ease symptoms of the disease.

Discuss these treatments with your doctor before initiating them on your own. He or she can help you weigh the benefits and risks and tell you if the treatments will interfere adversely with your current lupus medications.

Complementary and alternative treatments for lupus include:

Dehydroepiandrosterone (DHEA). Supplements containing this hormone may help fatigue and muscle pain. It may lead to acne in women.

Fish oil. Fish oil supplements contain omega-3 fatty acids that may be beneficial for people with lupus. Preliminary studies have found some promise, though more study is needed. Side effects of fish oil supplements can include nausea, belching and a fishy taste in the mouth.

Acupuncture. This therapy uses tiny needles inserted just under the skin. It may help ease the muscle pain associated with lupus.

Coping and support

If you have lupus, you're likely to have a range of painful feelings about your condition, from fear to extreme frustration. The challenges of living with lupus increase your risk of depression and related mental health problems, such as anxiety, stress and low self-esteem. To help you cope with lupus, try to:

Learn all you can about lupus. Write down any questions you have about lupus as they occur to you so that you can ask them at your next appointment. Ask your doctor or nurse for reputable sources of further information. The more you know about lupus, the more confident you'll feel in your treatment choices.

Gather support among your friends and family. Talk about lupus with your friends and family and explain ways they can help out when you're having flares. Lupus can be frustrating for your loved ones because they usually can't see it, and you may not appear sick.

Family and friends can't tell if you're having a good day or a bad day unless you tell them. Be open about what you're feeling so that your loved ones know what to expect.

Take time for yourself. Cope with stress in your life by taking time for yourself. Use that time to read, meditate, listen to music or write in a journal. Find activities that calm and renew you.

Connect with others who have lupus. Talk to other people who have lupus. You can connect with other people who have lupus through support groups in your community or through online message boards. Other people with lupus can offer unique support because they're facing many of the same obstacles and frustrations that you're facing.

Preparing for your appointment

You're likely to start by seeing your primary care doctor, but he or she may refer you to a specialist in the diagnosis and treatment of inflammatory joint conditions and immune disorders (rheumatologist).

Because the symptoms of lupus can mimic so many other health problems, you may need patience while waiting for a diagnosis. Your doctor must rule out a number of other illnesses before diagnosing lupus. You may need to see a number of specialists such as doctors who treat kidney problems (nephrologists), blood disorders (hematologists) or nervous system disorders (neurologists) depending on your symptoms to help with diagnosis and treatment.

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

When did your symptoms begin? Do they come and go?

Does anything seem to trigger your symptoms?

Have your parents or siblings had lupus or other autoimmune disorders?

What medications and supplements do you take regularly?

You may also want to write down questions to ask your doctor, such as:

What are the possible causes of my symptoms or condition?

What tests do you recommend?

If these tests don't pinpoint the cause of my symptoms, what additional tests might I need?

Are there any treatments or lifestyle changes that might help my symptoms now?

Do I need to follow any restrictions while we're seeking a diagnosis?

Should I see a specialist?

If you are considering pregnancy, be sure to discuss this with your doctor. Some medications cannot be used if you get pregnant.

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over any points you want to spend more time on. Your doctor may ask:

Does sun exposure cause you to develop skin rashes?

Do your fingers become pale, numb or uncomfortable in the cold?

Do your symptoms include any problems with memory or concentration?

How much do your symptoms limit your ability to function at school, at work or in personal relationships?

Have you been diagnosed with any other medical conditions?

Are you pregnant, or do you plan to become pregnant?

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Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders. No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis.

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Drug treatment for lupus can be PO, IV, IM, topical, and subcutaneous. The route of administration is based on the provider's orders. PO medicines can include NSAIDs, methotrexate, and prednisone. An IV medication could be methylprednisolone, an immunosuppressant, or a biologic. An IM medication could be triamcinolone. A topical steroid medication could be used. Subcutaneous medications could be biologics or methotrexate.

Reference: Johns Hopkins Medicine. (2025). Treating Lupus with Steroids. Johns Hopkins Lupus Center. https://www.hopkinslupus.org/lupus-treatment/lupus-medications/steroids/

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Prednisone

Prednisolone

Hydrocortisone

Methylprednisolone (Medrol)

Dexamethasone (Decadron)

Triamcinolone IM

IV methylprednisolone (Solu-Medrol)

Topical Steroids

What are steroids, and why are they used to treat lupus?

Steroids are a group of chemicals that make up a large portion of the hormones in your body. One of these steroids, cortisone, is a close relative of cortisol, which the adrenal glands in your body make as a natural anti-inflammatory hormone. Synthetic cortisone medications are some of the most effective treatments for reducing the swelling, warmth, pain, and tenderness associated with the inflammation of lupus. Cortisone usually works quickly to relieve these symptoms. However, cortisone can also cause many unwelcome side effects, so it is usually prescribed only when other medications-specifically NSAIDs and anti-malarials-are not sufficient enough to control lupus.

The word "steroid" often sounds frightening because of the media attention given to the anabolic steroids that some athletes use to put on muscle. However, it is important to remember that steroids make up a large group of molecules with different functions, and the steroids given to treat lupus-specifically, corticosteroids-are different than those you may hear about on the news.

How do corticosteroids work to reduce inflammation in the body?

Inflammation is the body's natural response to events such as injury, infection, and the presence of foreign substances-things your body doesn't recognize as a part of itself. Sometimes, however, as with lupus, your body's immune system does not function properly, and the inflammatory response works to damage your own tissues, causing stiffness, swelling, warmth, pain, and tenderness in different parts of the body. Corticosteroids help to slow and stop the processes in your body that make the molecules involved in your inflammatory response. These steroids also reduce the activity of your immune system by affecting the function of cells in your blood called white blood cells. In reducing inflammation and immune response, corticosteroids help to prevent damage to the tissues in your body.

What steroid medications are commonly prescribed for lupus?

Prednisone is the steroid most commonly prescribed for lupus. It is usually given as tablets that come in 1, 5, 10, or 20 milligram (mg) doses. Pills may be taken as often as 4 times a day or as infrequently as once every other day. Usually, a low dose of prednisone is about 7.5 mg per day or less, a medium dose is between 7.5 and 30 mg per day, and a dose of more than 30 mg qualifies as a high dose. Your doctor may also prescribe a similar drug called prednisolone, especially if you have had any liver problems. Prednisolone and prednisone are very similar. In fact, the liver must convert prednisone to prednisolone before the body can use it.

Sometimes lupus flares can be treated with an intra-muscular (IM) injection of a drug called Triamcinolone. These injections are usually given at your doctor's office, and they often reduce flares without some of the side-effects that would accompany an increase in the dosage of an oral steroid like prednisone. Usually, the only noticeable side effect of these injections is a dimple or loss of pigmentation at the injection sight.

Steroids can also be given intravenously (IV) in the form of methylprednisolone (Solu-Medrol), and your doctor may prescribe higher doses of methylprednisolone (1000 mg) given over 3-5-day period. These treatments are often referred to as "pulse steroids." Other forms of steroid medications commonly given for lupus are hydrocortisone, methylprednisolone (Medrol) dose packs, and dexamethasone (Decadron) tablets. These medications vary in potency. For example, hydrocortisone is weaker than prednisone, methylprednisolone is stronger, and dexamethasone is very potent. Ointments containing corticosteroids are also commonly prescribed for lupus rashes.

What are the side effects of steroid medications?

Steroid medications can have serious long-term side effects, and the risk of these side effects increases with higher doses and longer term therapy. For this reason, steroid medications are usually prescribed only after other less potent drugs have proven insufficient in controlling your lupus. Your doctor will work with you to determine the lowest dose of steroids necessary to control your lupus symptoms and will prescribe steroids for the shortest possible amount of time. Steroids are sometimes combined with other drugs to help reduce some of these side effects.

Possible side effects of taking these steroid medications are:

Changes in appearance

Acne

Development of round/moon-shaped face (sometimes called "Cushing's syndrome" after the physician who first described it)

Weight gain due to increased appetite

Redistribution of fat, leading to swollen face and abdomen, but thin arms and legs

Increased skin fragility, leading to easy bruising

Hair growth on the face

Psychological problems

Irritability

Agitation, psychosis

Euphoria/depression (mood swings)

Insomnia

Increased susceptibility to infections

Stomach irritation, peptic ulceration

Irregular menses (periods)

Potassium deficiency

Aggravation of the following preexisting conditions:

Diabetes

Glaucoma

High blood pressure

Increase in:

Cholesterol

Triglycerides

May suppress growth in children

Long term side effects:

Avascular necrosis of bone (death of bone tissue due to lack of blood supply):

Usually associated with high doses of prednisone taken over long periods of time.

Produces pain, including night pain. Pain relief usually requires either a core bone biopsy or total surgical joint replacement.

Occurs most often in hip, but can also affect shoulders, knees, and other joints.

Osteoporosis

Thinning of the bones.

Can lead to bone fractures, especially compression fractures of vertebrae with severe back pain.

Cataracts

Glaucoma

Muscle weakness

Premature atherosclerosis - narrowing of the blood vessels by cholesterol (fat) deposits.

Pregnancy complications -Doses of 20mg or more have shown to increase pregnancy and birth complications, such as preeclampsia.

What can I do to stay as healthy as possible while taking my steroid medications?

While taking steroid medications such as prednisone, it may seem that your body's reactions to the things you do and the food you eat are out of your hands. If you feel overwhelmed or frustrated with some of the outward effects of your medications, your doctor can help you to come up with some strategies to minimize side-effects. However, it is important to realize that you play the most important role in helping yourself to stay as healthy as possible. There are many things you can do on a daily basis to help minimize the side effects of both steroid medications and your lupus symptoms.

Diet

A healthy diet is important for everyone, but it is especially important for people with lupus and those taking steroid medications. While taking steroids, your cholesterol, triglyceride, and blood sugar levels may increase. For these reasons, it is absolutely essential that you not increase your calorie intake and follow a low sodium, low-fat, and low-carbohydrate diet. You do not need to cut out all of the foods you love, but concentrate on eating whole grain breads and cereals and lean sources of protein such as chicken and fish.* When you need a snack, look to vegetables-they are low in sugar and calories and provide the perfect food for "grazing." Try to eat them without Ranch dressing or vegetable dip, because these items carry lots of fat and calories. If you need something to accompany your vegetables, try lighter dips like hummus. It is also important that you minimize alcohol intake when taking steroid medications, since steroids may already irritate your stomach. In fact, it is best not to drink alcohol at all, because combining alcohol with certain lupus medications can be very harmful to your liver.

Steroids may deplete certain vitamins in your body, such as vitamins C, D, and potassium. Your doctor may recommend for you to take supplemental vitamins or increase your intake of certain foods in order to make up for these deficiencies. Usually it is beneficial to take a multivitamin every day, but speak with your doctor to see which one is right for you, since some vitamins can adversely affect certain conditions. For example, people with antiphospholipid antibodies, especially those taking anticoagulants such as warfarin (Coumadin), should avoid vitamin K because it can increase the risk of blood clots.

Osteoporosis

Steroids can also contribute to a thinning of the bones known as osteoporosis, which may put you at an increased risk for bone fractures. Your doctor may prescribe a drug for osteoporosis or advise you to take a calcium or hormone supplement. Bisphosphonates such as Actonel, Fosamax, and Boniva are commonly prescribed, as are parathyroid hormone (Forteo) and other medications. To help keep your bones as strong as possible, try to increase your intake of calcium and vitamin D. Calcium helps to keep bones strong and vitamin D helps your body make use of calcium. Foods high in calcium include milk and milk products, tofu, cheese, broccoli, chard, all greens, okra, kale, spinach, sourkraut, cabbage, soy beans, rutabaga, salmon, and dry beans.

Staying Active

In addition to increasing your risk of osteoporosis, steroid medications can weaken your muscles. Staying as active as possible will help you to maintain strong muscles and bones. Weight-bearing activities such as walking, dancing, and running will help your muscles stay strong and healthy. Many people report that these activities make them feel better mentally as well. In fact, there are actually chemicals in your brain triggered by significant exercise (usually about 30 minutes per day) that help you to attain a "natural high." Your doctor can help you to assess your personal condition and decide on an exercise routine that is best for you. However, you should never put yourself through more than reasonable discomfort when exercising.

Smoking

People with lupus should never smoke due to their increased risk of cardiovascular disease. Steroid medications increase this risk by upping blood pressure, triglycerides, and cholesterol. Smoking, steroids, and lupus make a very bad combination.

Infection

Steroid medications can also increase the risk of infection; this risk increases if you are also taking immunosuppressive drugs. For this reason, it is important that you try to avoid colds and other infections. Washing your hands regularly is perhaps the best way to keep germs at bay. More serious infections can lead to serious-even fatal-illness. The infections that most worry doctors are kidney infection, a type of skin infection called cellulitis, urinary tract infections, and pneumonia. It is important to be on the lookout for any changes in your health, because people taking steroids may not run a fever even though they are very ill. If these infections go untreated, they could enter the bloodstream and pose an even bigger threat, so it is important that you notify your doctor at the first signs of an infection or illness. In addition, live virus vaccines, such as FluMist, the small pox vaccine, and the shingles vaccine (Zostavax) should be avoided because they may cause disease in individuals taking steroid medications.

Eye Exams

Finally, since medications can increase your risk of cataracts and aggravate glaucoma, try to get an eye exam twice a year. Notify your doctor of any major changes in your vision.

Do not abruptly stop taking steroids

You should not stop taking steroids abruptly if you have been taking them for more than 4 weeks. Once your body has adjusted to taking steroids, your adrenal glands may shrink and produce less natural cortisone. Therefore, it is important to slowly reduce the dosage of steroids to allow the adrenal glands to gradually regain their ability to produce cortisone on their own.

Are there other drugs that I might take while taking steroids?

Steroids are often given in high doses, which may increase the risk of side effects. Medications called "immunosuppressive" drugs are sometimes prescribed in addition to steroids to help spare some of these undesirable side effects. However, as their name suggests, immunosuppressive work to suppress the immune system, so when taking these drugs, it is important to watch out for infection and notify your doctor at any sign of illness. If you do acquire an infection, you may be prescribed an antibiotic or other medication, but be sure to stay away from Bactrim, since this medication can cause flares in some people with lupus.

Because of the risk of osteoporosis, your doctor may also prescribe a bisphosphonate such as Actonel, Fosamax, or Boniva. She/he may also recommend taking calcium or vitamin D supplements to reduce bone thinning. Your doctor may also prescribe a diuretic to deal with bloating, fluid retention, and hypertension (high blood pressure).

In addition, since cortisone can cause elevated cholesterol, your doctor may prescribe statins such as Lipitor, Crestor, Vytorin, or Caduet. These medications work to lower cholesterol.

∗ The omega 3 fatty acids in fish and fish oil also have anti-inflammatory properties, which may help to reduce some of the discomfort in your joints and muscles.

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Treating Lupus with Steroids : Johns Hopkins Lupus Center

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Cortisone medications are some of the most effective treatments for reducing the swelling, warmth, pain, and tenderness associated with lupus inflammation.

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Administration of the medications varies. The client can administer oral medication at home. Intravenous infusions must be done by a registered nurse, either inpatient or outpatient. Topical can be administered by the client at home. With the proper education, clients can administer PO, IM, topical, and subcutaneous medications at home.

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Reference: Norris, T. L. (2024). Porth's Pathophysiology (11th ed.). Wolters Kluwer Health.

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SLE can cause inflammation and damage to multiple organs (joints, tendons, skin, heart, lungs, brain, kidneys, and blood vessels). Patients with SLE can experience major symptoms, such as fatigue, skin rashes, fever, and joint pain. Patients can develop skin sensitivity, oral ulcers, arthritis, kidney disease, and immunological abnormalities.

References: Ji Woon Ko, Russell, M., Lenert, A., & Sujin Kim. (2022). Development of an Information Value Chain for Systemic Lupus Erythematosus. Korean Journal of Adult Nursing, 34(3), 324–337. https://doi.org/10.7475/kjan.2022.34.3.324

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Patients with SLE are treated with different drug therapies. These include major medications such as hydroxychloroquine, glucocorticoids, immunosuppressive therapy, biologics, and non-steroidal anti-inflammatory drugs.

References: Ji Woon Ko, Russell, M., Lenert, A., & Sujin Kim. (2022). Development of an Information Value Chain for Systemic Lupus Erythematosus. Korean Journal of Adult Nursing, 34(3), 324–337. https://doi.org/10.7475/kjan.2022.34.3.324

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Major medications include corticoids, immunosuppressive therapy (i.e., methotrexate, mycophenolate mofetil, azathioprine, and cyclophosphamide), and biologics (i.e., belimumab, rituximab).

References: Ji Woon Ko, Russell, M., Lenert, A., & Sujin Kim. (2022). Development of an Information Value Chain for Systemic Lupus Erythematosus. Korean Journal of Adult Nursing, 34(3), 324–337. https://doi.org/10.7475/kjan.2022.34.3.324