However the effect is often short lived and the treatment usually needs to be supplemented by some oral medication. The commonest oral medication to be recommended are the antimalarials, hydroxychloroquine and chloroquine. Both of these are effective in reducing joint pain and inflammation over a long period of time, but they can take up to 3 months to become effecilve. Steroids by mouth are also effectlve in controlling joint pain but because of their long-term side effects they are usually held in reserve. Sometimes joint pain and inflammation can be particularly troublesome and stronger drugs such as azathioprine, methotrexate and cyclosporin are needed to control the arthritis.
Surgery can be helpful for some people.
Hand surgeons can correct some of the hand deformities with operations on the tendons, ligaments and joints. Orthopaedic surgeons can replace some of the larger joints, for example knees and hips, if they are particularly badly damaged. Surgery is a big undertaking in people with lupus and the disease needs to be well controlled to make the procedure as safe as possible and to increase the likelihood of a good result from the operation. Lupus can affect the muscles in a number of ways. The commonest cause of muscle pain is related to arthritis in nearby joints and in this case treating the joints also helps the muscle pain.