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Being new to the Lupus world, I am hearing conflicting views from all sorts of physicians (living both in Canada and the USA). What are the top medications to treat the symptoms of Lupus? I heard Lyrica and Cymbalta are great, but another doctor told me that the other doctor was misinformed, but neglected to tell me an alternative (just bad mouthed the other doctor). What are the typical, common, top medications used to treat the symptoms of Lupus? Thanks!

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Your question is difficult to answer (but still interesting) because lupus is a highly heterogeneous condition which can present various symptoms and organ involvement. Choice of therapy will be tailored on the patient symptoms and his disease activity and severity.

Here a broad overview of the current management strategies of lupus:

  • The most frequent used of therapy in lupus patients (with any degree of disease activity) should be hydroxychloroquine or chloroquine (which are actually antimalarial drugs). These two drugs are associated with symptoms relief and reduction of lupus flares, thrombotic events and organe damage.
  • Other therapies can be used, depending on the severity of the disease and the activity such as NSAID, prednison (short term therapy) or steroid-sparing immunosuppressive therapy such as azathioprine or methotrexate.

Recently, rituximab, cyclophosphamide, cyclosporine and rituximab have been increasing used as long term therapy in lupus patients.

Finally, depending on the organ system involved, additionally strategies can be used. I don't know your case and why Lyrica (=pregabalin) or Cymbalta (=duloxetine) have been suggested by your physician. Some studies suggest that both pregabalin and duloxetine can be used as second line treatment in arthritis-related pain.

All above mentioned treatment should be started by a health professional as most of them need close monitoring and blood/radiological tests before some of these drugs are started.

I would suggest following website, which contains very useful information for patients with lupus: http://www.uptodate.com/contents/systemic-lupus-erythematosus-sle-beyond-the-basics

Sources:

  • van Laar et al. Pain treatment in arthritis related pain: Beyond NSAIDs. Open Rheumatol J. 2012. 6: 320-330
  • Wallace DF. Overview of the management and prognosis of systemic lupus erythrematosus in adults. Uptodate. 07.2016
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