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Without treatment, lupus progresses in flares, alternating with phases of relative calm. Unfortunately, this "natural" course, without proper treatment, is likely to lead not only to irreversible damage to the organs affected by the disease, in particular the kidneys (kidney failure) and the brain, but can also put the patient’s life on the line.
Under treatment, lupus usually evolves towards remission: disappearance of clinical signs and improvement of certain biological signs, such as the level of anti-DNA antibodies. However, antinuclear antibodies often remain present, even when lupus is completely controlled. The goal is to maintain remission with a minimal dose therapy (minimum effective treatment).
This usually means treatment with synthetic antimalarials (such as hydroxychloroquine, , chloroquine) to be taken several years after achieving remission.
Cortisone and sometimes immunosuppressants are also prescribed longterm.
If treatment is well followed, without untimely interruptions, the risk by flares is lower, and they are rarer. Early and sufficiently intensive treatment of flares makes it possible to considerably limit the sequelae and avoid a fatal outcome that has become very rare today.
Most often, lupus is put under control, thanks to a treatment that includes synthetic antimalarials, often corticosteroids, and sometimes immunosuppressants/biologics. The disease might progress through periods of flares followed by periods of "remission".
The more appropriate and earlier the treatment, the lower the risk of sequelae is.