evidence-based

Care Sheet

Systemic Lupus Erythematosus and Alternative

Therapy

What We Know
 Systemic lupus erythematosus (SLE) is a chronic and incurable autoimmune disease in which the body creates
antibodies to its own cells, serum proteins, and tissues, resulting in inflammation of, and damage to, multiple
tissues and organs. (See Quick Lesson About...Systemic Lupus Erythematosus.)(9)
 Traditional treatments consist mainly of medications, including corticosteroids, nonsteroidal anti-inflammatory
drugs (NSAIDs), immunosuppressive drugs, and antimalarial drugs(9)
 Alternative therapies, including homeopathy, naturopathy, chiropractic, and herbal medicine, have not been
shown to be safe and effective in the treatment of SLE(9)
 More than 50% of patients with SLE have used an alternative therapy at least once(12)
 Patients may be dissatisfied with traditional medicine due to its failure to provide a sense of well-being and the
occurrence of medication-related adverse effects(10, 13)
 Physicians and other traditional healthcare providers may have concerns regarding the use of alternative
therapies for SLE due to potential side effects, lack of government regulation, the cost to the patient and
insurance company, and possible interactions with traditional medical treatments(12)
 Dietary supplements and herbs that seem promising but require further clinical investigation to ensure safety
and/or efficacy include(1, 2, 3, 4, 5, 6, 7, 8, 9, 11, 12, 13, 14, 15, 16, 17, 18)

dehydroepiandrosterone (DHEA)
vitamins A, C, D, and E
omega-3 fatty acids, derived from fish oil and flaxseed, which may be effective in treatment of lupus
nephritis
ICD-10
M32

ICD-10-CAN
M32

beta-carotene
fiber
Chinese herbs
Tripterygium wilfordii Hook f., side effects of which include diarrhea, rash, skin color changes, and
temporary infertility; overdose can lead to kidney, heart, and gastrointestinal damage

Author
Sharon Richman, MSPT

Reviewers
Sara Grose, MSN, RN, PHN, CNL, CLE
Cinahl Information Systems
Glendale, California
Terri Van Houten, RN, BSN, BC
Director of Medical Surgical Services
Glendale Adventist Medical Center
Glendale, California
Nursing Practice Council
Glendale Adventist Medical Center
Glendale, California

Editor
Diane Pravikoff, RN, PhD, FAAN
Cinahl Information Systems

Atractylodes ovata, Angelica sinensis, Cordyceps sinensis, Ligustrum lucidum, and Codonopsis pilosula
have been found to be effective in animal models

The herbs willow, echinacea, astragalus, and alfalfa sprouts may exacerbate SLE or interfere with
commonly used medications

Lifestyle changes that positively affect overall health and quality of life, and may decrease SLE disease
activity, include a healthy, low-fat diet, smoking cessation, stress management, and aerobic exercise

Other techniques that are promising and presumed safe but require further clinical investigation to ensure
efficacy include acupuncture, massage, moxibustion, cognitive behavioral therapy with biofeedback, tai chi,
yoga, meditation, and reflexology
 Preliminary research suggests that clearing Fei, cooling blood, detoxifying blood, and nourishing yin by
administering a Chinese recipe Lang Chuang No. 1 or 2 may help modulate levels of T helper and T cytotoxic
cells which could help prevent infection in patients with SLE(19)

What We Can Do
 Learn about SLE, including signs and symptoms of complications, so you can accurately assess your patients
personal characteristics and health education needs; share this knowledge with your colleagues
 Become knowledgeable about alternative therapy treatments for SLE so you can discuss their potential risks,
limitations, and benefits with your patients(6, 15)

July 22, 2011

 Encourage your patients to routinely disclose to their primary clinician all herbs, supplements, or other

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general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206

alternative therapies they currently use or have previously used(6, 15)

 Encourage your patients to maintain good health and become educated regarding the details of positive lifestyle changes, including

how to initiate and maintain a regular exercise program

the components of good nutrition and a healthy diet
participation in an appropriate smoking cessation program

Coding Matrix

References

References are rated in order of strength:

1. Clark, W. F., Partbtani, A., Huff, M. W., Spanner, E., de Salis, H, Chin-Yee, I., Holub, B . J. (1995). Flaxseed: A potential treatment for lupus nephritis. Kidney
International, 48(2), 475-480. (R)
2. Duffy, E. M., Meenagh, G. K., McMillan, S. A., Strain, J. J., Hannigan, B. M., & Bell, A. L. (2004). The clinical effect of dietary supplementation with omega-3 fish oils
and/or copper in systemic lupus erythematosus. Journal of Rheumatology, 31(8), 1551-1556. (RCT)
3. Formica, M. K., Palmer, J. R., Rosenberg, L., & McAlindon, T. E. (2003). Smoking, alcohol consumption, and risk of systemic lupus erythematosus in the Black
Womens Health Study. Journal of Rheumatology, 30(6), 1222-1226. (R)
4. Ghaussy, N. O., Sibbitt, W. L., Jr., Bankhurst, A. D., & Qualls, C. R. (2003) Cigarette smoking and disease activity in systemic lupus erythematosus. Journal of
Rheumatology, 30(6), 1215-1221. (R)
5. Greco, C., Rudy, T. E., & Manzi, S. (2004). Effects of a stress-reduction program on psychological function, pain, and physical function of systemic lupus
erythematosus patients: A randomized controlled trial. Arthritis and Rheumatism, 51(4), 625-634. (RCT)
6. Haija, A. J., & Schulz, S. W. (2011). The role and effect of complementary and alternative medicine in systemic lupus erythematosus. Rheumatic Diseases Clinics of
North America, 37(1), 47-62. (GI)
7. Huang, H. C., Chou, C. T., Lin, K. C., & Chao, Y. F. C. (2007). The relationships between disability level, health-promoting lifestyle, and quality of life in outpatients
with systemic lupus erythematosus. Journal of Nursing Research, 15(1), 21-32. (R)
8. Kung Y. Y., Chen F. P., & Hwang S. (2006). The different immunomodulation of indirect moxibustion on normal subjects and patients with systemic lupus
erythematosus. American Journal of Chinese Medicine, 34(1), 47-56. (R)
9. Leiba, A., Amital, H., Gershwin, M. E., & Shoenfeld, Y. (2001). Diet and lupus. Lupus, 10(3), 246-248. (RV)
10. Leong, K. P., Pong, L. Y., & Chan, S. P. (2003). Why lupus patients use alternative medicine. Lupus, 12(9), 659-664. (R)
11. Minami, Y., Sasaki, T., Arai, Y., Kurisu, Y., & Hisamichi, S. (2003). Diet and systemic lupus erythematosus: A 4 year prospective study of Japanese patients. Journal
of Rheumatology, 30(4), 747-754. (R)
12. Moore, A. D., Petri, M. A., Manzi, S., Isenberg, D. A., Gordon, C., Senecal, J., Clarke, A. E. (2000). The use of alternative medical therapies in patients with
systemic lupus erythematosus. Arthritis and Rheumatism, 43(6), 1410-1418. (R)
13. Patavino, T., & Brady, D. M. (2001). Natural medicine and nutritional therapy as an alternative treatment in systemic lupus erythematosus. Alternative Medicine
Review, 6(5), 460-471. (RV)
14. Shah, M., Coyle, Y., Kavanaugh, A., Adams-Huet, B., & Lipsky, P. E. (2000). Development and initial evaluation of a culturally sensitive cholesterol-lowering diet
program for Mexican and African American patients with systemic lupus erythematosus. Arthritis Care and Research, 13(4), 205-212. (R)
15. Shirato, S. (2005). How CAM helps systemic lupus erythematosus. Holistic Nursing Practice, 19(1), 36-39. (RV)
16. Stewart, K. L. (2005). Health explorer: The wolf at the door. Better Nutrition, 67(7), 30-33. (X)
17. Strmbeck, B., & Jacobsson, T. H. (2007). The role of exercise in the rehabilitation of patients with systemic lupus erythematosus and patients with primary Sjgrens
syndrome. Current Opinion in Rheumatology, 19(2), 197-203. (SR)
18. Tam, L. S., Li, E. K., Leung, V. Y. F., Griffith, J. F., Benzie, I. F. F., Lim, P. L., Tomlinson, B. (2005). Effects of vitamins C and E on oxidative stress markers and
endothelial function in patients with systemic lupus erythematosus: A double blind, placebo controlled pilot study. Journal of Rheumatology, 32(2), 275-282. (RCT)
19. Xiao-juan, T., Zheng, H. X., Yu, J. N., Ma, J. L., & Zhang, W. (2008). Regulatory effect of Langchuang serial recipes on T-lymphocye subsets Th and Tc in patients
with systemic lupus erythematosus. Chinese Journal of Integrative Medicine, 14(3), 180-184. (RCT)

M Published meta-analysis

SR Published systematic or integrative literature review

RCT Published research (randomized controlled trial)

R Published research (not randomized controlled trial)

C Case histories, case studies

G Published guidelines

RV Published review of the literature

RU Published research utilization report

QI Published quality improvement report

L Legislation

PGR Published government report

PFR Published funded report

PP Policies, procedures, protocols

X Practice exemplars, stories, opinions

GI General or background information/texts/reports

U Unpublished research, reviews, poster

presentations or other such materials

CP Conference proceedings, abstracts, presentations