It is estimated that over 50 % of patients with systemic lupus erythematosus (SLE) have utilized complementary and alternative medicine (CAM) treatments to reduce symptoms and manage their health. However, there are relatively few randomized controlled trials of CAM for SLE. This review describes recent studies of vitamins and supplements, acupuncture, and mind-body interventions in SLE patients. The recent trials of CAM treatments for SLE indicate that supplements such as vitamin D, omega 3 fatty acids, N-acetyl cysteine and turmeric show some promise for reducing SLE disease activity. In addition, mind-body methods such as cognitive-behavioral therapy and other counseling interventions may improve mood and quality of life in SLE.
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Manzi S, Meilahn E, Rairie J, Conte C, Medsger T, Jansen-McWilliams L, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol. 1997;145(5):408–15.
Ward M. Premature morbidity from cardiovascular and cerebrovascular diseases in women with systemic lupus erythematosus. Arthritis Rheum. 1999;42(2):338–46.
Bachen EA, Chesney MA, Criswell LA. Prevalence of mood and anxiety disorders in women with systemic lupus erythematosus. Arthritis Rheum. 2009;61(6):822–9.
• Haija AJ, Schulz SW. The role and effect of complementary and alternative medicine in systemic lupus erythematosus. Rheum Dis Clin North Am. 2011;37(1):47–62. This paper provides a review and discussion of CAM in SLE and other rheumatologic conditions.
Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report. 2008;(12):1–23.
Bailey RL, Gahche JJ, Miller PE, Thomas PR, Dwyer JT. Why US adults use dietary supplements. JAMA Intern Med. 2013;173(5):355–61.
Moore AD, Petri MA, Manzi S, Isenberg DA, Gordon C, Senecal JL, et al. The use of alternative medical therapies in patients with systemic lupus erythematosus. Trination Study Group. Arthritis Rheum. 2000;43(6):1410–8.
Leong KP, Chan SP. Why Lupus patients use alternative medicine. Lupus. 2003;12:659–64.
Alvarez-Nemegyei J, Bautista-Botello A. Complementary or alternative therapy use and health status in systemic lupus erythematosus. Lupus. 2009;18:159–63.
Aghdassi E, Morrison S, Landolt-Marticorena C, Su J, Pineau CA, Gladman D, et al. The use of micronutrient supplements is not associated with better quality of life and disease activity in Canadian patients with systemic lupus erythematosus. J Rheumatol. 2010;37(1):87–90.
Costenbader KH, Kang JH, Karlson EW. Antioxidant intake and risks of rheumatoid arthritis and systemic lupus erythematosus in women. Am J Epidemiol. 2010;172(2):205–16.
Hiraki LT, Munger KL, Costenbader KH, Karlson EW. Dietary intake of vitamin D during adolescence and risk of adult-onset systemic lupus erythematosus and rheumatoid arthritis. Arthritis Care Res. 2012;64(12):1829–36.
Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–81.
Kamen DL, Aranow C. The link between vitamin D deficiency and systemic lupus erythematosus. Curr Rheumatol Rep. 2008;10(4):273–80.
Kamen DL. Vitamin D in lupus - new kid on the block? Bull NYU Hosp Jt Dis. 2010;68(3):218–22.
Szodoray P, Tarr T, Bazso A, Poor G, Szegedi G, Kiss E. The immunopathological role of vitamin D in patients with SLE: data from a single centre registry in Hungary. Scand J Rheumatol. 2011;40(2):122–6.
Ravenell RL, Kamen DL, Spence JD, Hollis BW, Fleury TJ, Janech MG, et al. Premature atherosclerosis is associated with hypovitaminosis D and angiotensin-converting enzyme inhibitor non-use in lupus patients. Am J Med Sci. 2012;344(4):268–73.
Yeap SS, Othman AZ, Zain AA, Chan SP. Vitamin D levels: its relationship to bone mineral density response and disease activity in premenopausal Malaysian systemic lupus erythematosus patients on corticosteroids. Int J Rheum Dis. 2012;15(1):17–24.
• Abou-Raya A, Abou-Raya S, Helmii M. The Effect of Vitamin D Supplementation on Inflammatory and Hemostatic Markers and Disease Activity in Patients with Systemic Lupus Erythematosus: A Randomized Placebo-controlled Trial. J Rheumatol. 2013;40(3):265–72. This paper describes a RCT of Vitamin D in 178 SLE patients. Twelve months of supplementation was associated with reduction in SLEDAI as well as modulation of proinflammatory and hemostatic markers.
Aranow C, Dall'Era M, Massarotti EM, Mackay M, Coca A, Koumpouras F, et al. A double-blind randomized placebo-controlled trial of the effect of vitamin D3 on the interferon signature in patients with systemic lupus erythematosus. Arthritis Rheum. 2012;64(10 (supplement)):S1110.
Minami Y, Sasaki T, Arai Y, Kurisu Y, Hisamichi S. Diet and systemic lupus erythematosus: a 4 year prospective study of Japanese patients. J Rheumatol. 2003;30(4):747–54.
Minami Y, Hirabayashi Y, Nagata C, Ishii T, Harigae H, Sasaki T, et al. Intakes of vitamin B6 and dietary fiber and clinical course of systemic lupus erythematosus: a prospective study of Japanese female patients. J Epidemiol. 2011;21(4):246–54.
Tam LS, Li EK, Leung VY, Griffith JF, Benzie IF, Lim PL, et al. 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. J Rheumatol. 2005;32(2):275–82.
Ward M. Cardiovascular and cerebrovascular morbidity and mortality among women with end-stage renal disease attributable to lupus nephritis. Am J Kidney Dis. 2000;36(3):516–25.
Bucher HC, Hengstler P, Schindler C, Meier G. N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med. 2002;112(4):298–304.
James MJ, Gibson RA, Cleland LG. Dietary polyunsaturated fatty acids and inflammatory mediator production. Am J Clin Nutr. 2000;71(1 Suppl):343S–8S.
Duffy EM, Meenagh GK, McMillan SA, Strain JJ, Hannigan BM, Bell AL. The clinical effect of dietary supplementation with omega-3 fish oils and/or copper in systemic lupus erythematosus. J Rheumatol. 2004;31(8):1551–6.
Wright SA, O'Prey FM, McHenry MT, Leahey WJ, Devine AB, Duffy EM, et al. A randomised interventional trial of omega-3-polyunsaturated fatty acids on endothelial function and disease activity in systemic lupus erythematosus. Ann Rheum Dis. 2008;67(6):841–8.
Clark WF, Parbtani A, Huff MW, Reid B, Holub BJ, Falardeau P. Omega-3 fatty acid dietary supplementation in systemic lupus erythematosus. Kidney Int. 1989;36(4):653–60.
Clark WF, Parbtani A, Naylor CD, Levinton CM, Muirhead N, Spanner E, et al. Fish oil in lupus nephritis: clinical findings and methodological implications. Kidney Int. 1993;44(1):75–86.
Walton AJ, Snaith ML, Locniskar M, Cumberland AG, Morrow WJ, Isenberg DA. Dietary fish oil and the severity of symptoms in patients with systemic lupus erythematosus. Ann Rheum Dis. 1991;50(7):463–6.
Gergely Jr P, Grossman C, Niland B, Puskas F, Neupane H, Allam F, et al. Mitochondrial hyperpolarization and ATP depletion in patients with systemic lupus erythematosus. Arthritis Rheum. 2002;46(1):175–90.
Shah D, Aggarwal A, Bhatnagar A, Kiran R, Wanchu A. Association between T lymphocyte sub-sets apoptosis and peripheral blood mononuclear cells oxidative stress in systemic lupus erythematosus. Free Radic Res. 2011;45(5):559–67.
Tewthanom K, Janwitayanujit S, Totemchockcyakarn K, Panomvana Na Ayudhya D. The effect of high dose of N-acetylcysteine in lupus nephritis: a case report and literature review. J Clin Pharm Ther. 2010;35(4):483–5.
Tewthanom K, Janwitayanujit S, Totemchockchyakarn K, Panomvana Na Ayudhya D. Pharmacodynamic effect of N-Acetylcysteins as adjunctive therapy in mild systemic lupus erythematosus patients. Trop J Pharm Res. 2011;10(2):141–6.
• Lai Z-W, Hanczko R, Bonilla E, Caza TN, Clair B, Bartos A, et al. N-acetylcysteine reduces disease activity by blocking mammalian target of rapamycin in T cells from systemic lupus erythematosus patients: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2012;64(9):2937–46. This study evaluated 3 doses of NAC and placebo in 36 SLE patients. Positive effects were found on SLEDAI scores, anti-dsDNA, and BILAG.
• Garcia RJ, Francis L, Dawood M, Lai ZW, Faraone SV, Perl A, et al. Attention deficit and hyperactivity disorder scores are elevated and respond to N-acetylcysteine treatment in patients with systemic lupus erythematosus. Arthritis Rheum. 2013;65(5):1313–8. In 24 SLE patients from the Lai et al. (2012) study, above, NAC was associated with self-reported improvements in cognitive function.
Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245–56.
Bright JJ. Curcumin and autoimmune disease. Adv Exp Med Biol. 2007;595:425–51.
Khajehdehi P, Zanjaninejad B, Aflaki E, Nazarinia M, Azad F, Malekmakan L, et al. Oral supplementation of turmeric decreases proteinuria, hematuria, and systolic blood pressure in patients suffering from relapsing or refractory lupus nephritis: a randomized and placebo-controlled study. J Ren Nutr. 2012;22(1):50–7.
Chang DM, Lan JL, Lin HY, Luo SF. Dehydroepiandrosterone treatment of women with mild-to-moderate systemic lupus erythematosus: a multicenter randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2002;46(11):2924–7.
Chang DM, Chu SJ, Chen HC, Kuo SY, Lai JH. Dehydroepiandrosterone suppresses interleukin 10 synthesis in women with systemic lupus erythematosus. Ann Rheum Dis. 2004;63(12):1623–6.
Petri MA, Lahita RG, Van Vollenhoven RF, Merrill JT, Schiff M, Ginzler EM, et al. Effects of prasterone on corticosteroid requirements of women with systemic lupus erythematosus: a double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2002;46(7):1820–9.
Petri MA, Mease PJ, Merrill JT, Lahita RG, Iannini MJ, Yocum DE, et al. Effects of prasterone on disease activity and symptoms in women with active systemic lupus erythematosus. Arthritis Rheum. 2004;50(9):2858–68.
van Vollenhoven RF, Park JL, Genovese MC, West JP, McGuire JL. A double-blind, placebo-controlled, clinical trial of dehydroepiandrosterone in severe systemic lupus erythematosus. Lupus. 1999;8(3):181–7.
Sanchez-Guerrero J, Fragoso-Loyo HE, Neuwelt CM, Wallace DJ, Ginzler EM, Sherrer YR, et al. Effects of prasterone on bone mineral density in women with active systemic lupus erythematosus receiving chronic glucocorticoid therapy. J Rheumatol. 2008;35(8):1567–75.
Hartkamp A, Geenen R, Godaert GL, Bijl M, Bijlsma JW, Derksen RH, et al. Effects of dehydroepiandrosterone on fatigue and well-being in women with quiescent systemic lupus erythematosus: a randomised controlled trial. Ann Rheum Dis. 2010;69(6):1144–7.
van Vollenhoven RF, Morabito LM, Engleman EG, McGuire JL. Treatment of systemic lupus erythematosus with dehydroepiandrosterone: 50 patients treated up to 12 months. J Rheumatol. 1998;25(2):285–9.
Marder W, Somers EC, Kaplan MJ, Anderson MR, Lewis EE, McCune WJ. Effects of prasterone (dehydroepiandrosterone) on markers of cardiovascular risk and bone turnover in premenopausal women with systemic lupus erythematosus: a pilot study. Lupus. 2010;19(10):1229–36.
Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172(19):1444–53.
Greco CM, Kao AH, Maksimowicz-McKinnon K, Glick RM, Houze M, Sereika SM, et al. Acupuncture for systemic lupus erythematosus: a pilot RCT feasibility and safety study. Lupus. 2008;17(12):1108–16.
Scharf H, Mansmann U, Streitberger K, Witte S, Kramer J, Maier C, et al. Acupuncture and knee osteoarthritis. Ann Intern Med. 2006;145:12–20.
Josefson A, Kreuter M. Acupuncture to reduce nausea during chemotherapy treatment of rheumatic diseases. Rheumatology (Oxford). 2003;42:1149–54.
Sundquist K, Li X, Hemminki K, Sundquist J. Subsequent risk of hospitalization for heuropsyciatric disorders in patients with rheumatic diseases: a nationwide study from Sweden. Arch Gen Psychiatry. 2008;65(5):501–7.
Daleboudt GM, Broadbent E, McQueen F, Kaptein AA. Intentional and unintentional treatment nonadherence in patients with systemic lupus erythematosus. Arthritis Care Res. 2011;63(3):342–50.
Greco CM, Li T, Sattar A, Kao AH, Danchenko N, Edmundowicz D, et al. Association between depression and vascular disease in systemic lupus erythematosus. J Rheumatol. 2012;39(2):262–8.
Zhang J, Wei W, Wang C. Effects of psychological interventions for patients with systemic lupus erythematosus: a systematic review and meta-analysis. Lupus. 2012;21(10):1077–87.
Karlson EW, Liang MH, Eaton H, Huang J, Fitzgerald L, Rogers MP, et al. A randomized clinical trial of a psychoeducational intervention to improve outcomes in systemic lupus erythematosus. Arthritis Rheum. 2004;50(6):1832–41.
Harrison MJ, Morris KA, Horton R, Toglia J, Barsky J, Chait S, et al. Results of intervention for lupus patients with self-perceived cognitive difficulties. Neurology. 2005;65(8):1325–7.
Drenkard C, Dunlop-Thomas C, Easley K, Bao G, Brady T, Lim SS. Benefits of a self-management program in low-income African-American women with systemic lupus erythematosus: results of a pilot test. Lupus. 2012;21(14):1586–93.
Navarrete-Navarrete N, Peralta-Ramirez MI, Sabio-Sanchez JM, Coin MA, Robles-Ortega H, Hidalgo-Tenorio C, et al. Efficacy of cognitive behavioural therapy for the treatment of chronic stress in patients with lupus erythematosus: a randomized controlled trial. Psychother Psychosom. 2010;79(2):107–15.
Greco CM, Rudy TE, Manzi S. Effects of a stress-reduction program on psychological function, pain, and physical function of systemic lupus erythematosus patients: a randomized controlled trial. Arthritis Rheum. 2004;51(4):625–34.
Brown RT, Shaftman SR, Tilley BC, Anthony KK, Kral MC, Maxson B, et al. The health education for lupus study: a randomized controlled cognitive-behavioral intervention targeting psychosocial adjustment and quality of life in adolescent females with systemic lupus erythematosus. Am J Med Sci. 2012;344(4):274–82.
Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study. Pain. 2008;134(3):310–9.
Kabat-Zinn J, Wheeler EP, Light T, Skillings A, Scharf MJ, Cropley TG, et al. Influence of a Mindfulness Meditation-Based Stress Reduction Intervention on Rates of Skin Clearing in Patients With Moderate to Severe Psoriasis Undergoing Photo Therapy (UVB) and Photochemotherapy (PUVA). Psychosom Med. 1998;60(5):625–32.
Rosenkranz MA, Davidson RJ, Maccoon DG, Sheridan JF, Kalin NH, Lutz A. A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain Behav Immun. 2013;27(1):174–84.
Pradhan EK, Baumgarten M, Langenberg P, Handwerger B, Gilpin AK, Magyari T, et al. Effect of Mindfulness-Based Stress Reduction in rheumatoid arthritis patients. Arthritis Rheum. 2007;57(7):1134–42.
Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. J Psychosom Res. 2010;68(1):29–36.
Zautra AJ, Davis MC, Reich JW, Nicassario P, Tennen H, Finan P, et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. J Consult Clin Psychol. 2008;76(3):408–21.
Carol M. Greco and Susan Manzi have received grant support from the National Institutes of Health (NIH) (R01 AR046588 and K24 AR002213 for Susan Manzi). Susan Manzi has also served on an NIAID-NIH study section. Carol M. Greco also receives support from the NIH-National Institute of Arthritis, Musculoskeletal and Skin Diseases (R01 AR057338) and National Center for Complementary and Alternative Medicine (R01 AT006453).
The authors would like to acknowledge and thank Dr. Mary Lou Klem, research librarian at the University of Pittsburgh’s Health Sciences Library System, for conducting literature searches for this article.
Compliance with Ethics Guidelines
Conflict of Interest
Susan Manzi serves on the board for the Lupus Foundation of America, serves as a consultant for Exagen Diagnostics, and has been the co-holder of several patents.
Carol M. Greco and Claire Nakajima declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with animal subjects performed by any of the authors. With regard to the authors’ research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.
This article is part of the Topical Collection on Complementary and Alternative Medicine
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Greco, C.M., Nakajima, C. & Manzi, S. Updated Review of Complementary and Alternative Medicine Treatments for Systemic Lupus Erythematosus. Curr Rheumatol Rep 15, 378 (2013). https://doi.org/10.1007/s11926-013-0378-3
- Systemic lupus erythematosus
- Complementary medicine
- Alternative medicine
- Integrative medicine
- Mind–body treatments
- Cognitive behavioral therapy
- Interpersonal therapy
- N-acetyl cysteine
- Vitamin D
- Vitamin C
- Vitamin E
- Vitamin B6
- Omega 3 fatty acids
- Fish oil
- Oxidative stress