Q: What treatments relieve arthritis and fatigue associated with systemic lupus erythematosus? A: Hydroxychloroquine and chloroquine improve the arthritis associated with mild systemic lupus erythematosus (SLE)--producing a 50% reduction in arthritis flares and articular involvement--and have few adverse effects (strength of recommendation [SOR]: a, systematic review of randomized controlled trials [RCTs]). Methotrexate reduces arthralgias by as much as 79%, but produces adverse effects in up to 70% of patients (SOR: b, systematic review of RCTs with limited patient-oriented evidence). Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are often used for SLE joint pain (SOR: c, expert opinion). Omega-3 fatty acids may reduce arthritis symptoms by about 35% (SOR: b, RCTs with inconsistent evidence). Abatacept and dehydroepiandrosterone don't produce clinically meaningful improvements in fatigue associated with SLE, and abatacept causes significant adverse effects (SOR: b, posthoc analysis of a single RCT). Aerobic exercise may help fatigue (SOR: b, systematic review with inconsistent evidence)
