ENThis page is for people with systemic lupus erythematosus (SLE) or a suspected diagnosis, and for their families. Lupus is an autoimmune disease: the immune system attacks the body’s own tissues — the skin, joints, kidneys and blood cells, and sometimes the heart, lungs and nervous system. It mostly affects young women and runs in flares that alternate with calm periods.
Lupus treatment in Germany starts with a careful check of which organs are involved, because the therapy depends on it. The page covers diagnosis, basic treatment, biologics and lupus nephritis, specialists, and how to arrange care. Rheumatoid arthritis is a different disease, covered on our page on rheumatoid arthritis treatment.
Confirming the diagnosis and checking the organs
The diagnosis rests on symptoms and test results, and then each organ at risk is checked. This comes first because lupus imitates other diseases, and many patients reach a rheumatologist after years of unclear symptoms. Doctors use the EULAR/ACR 2019 classification criteria, a structured checklist of test results and symptoms. The entry point is a positive test for antinuclear antibodies (ANA).
Blood tests cover ANA, antibodies against double-stranded DNA (anti-dsDNA), the complement proteins C3 and C4, and a full blood count. Urine is tested for protein and blood, which are often the first sign that the kidneys are involved. Antiphospholipid antibodies are measured as well: they raise the risk of blood clots and matter in pregnancy.
When protein appears in the urine, a kidney biopsy follows: a small tissue sample, viewed under the microscope, shows the type of kidney inflammation and decides the treatment. The heart is checked by ultrasound, lung function is tested, and a neurologist examines the patient when there are neurological symptoms.
How lupus is treated: the basic principles
Hydroxychloroquine is the foundation for almost every patient unless there is a contraindication; cortisone is kept as low as possible, and immunosuppressants are added where needed. While hydroxychloroquine is being taken, the eyes are checked regularly.
Glucocorticoids (cortisone) calm a flare quickly. The dose is then reduced to the lowest possible or the drug is stopped, because long-term cortisone does its own harm. This is the line of the current European EULAR recommendations for the management of systemic lupus erythematosus. Immunosuppressants — methotrexate, azathioprine, mycophenolate — are chosen according to which organs are affected.
Everyday protection matters too. UV light can trigger flares, so sunscreen and avoiding strong sun help. Vaccinations are agreed with the rheumatologist, and smoking should stop. Pregnancy is planned for a calm phase: some drugs must be stopped or switched months beforehand, and the decision is made together with the rheumatologist and the gynaecologist.
Biologics, lupus nephritis and new approaches
When basic treatment is not enough, biologics are added: antibody drugs that block one specific signal of the immune system. Belimumab and anifrolumab are approved in the EU for active SLE in addition to standard therapy.
Lupus nephritis is the name for kidney involvement in lupus. It is treated with mycophenolate or cyclophosphamide, in some patients combined with newer drugs such as belimumab. The rheumatologist and the nephrologist work together, and if kidney function declines, see our page on kidney treatment.
CAR-T cell therapy works differently: the patient’s own immune cells are modified so that they remove the cells that produce harmful antibodies. The first results in severe lupus that had not responded to several immunosuppressants were published by the team at University Hospital Erlangen. For now it is used only within clinical studies under strict criteria and cannot be obtained on request.
Rheumatologists and hospitals for lupus in Germany
Lupus is treated by rheumatologists, with nephrologists joining when the kidneys are involved. Prof. Dr. med. Reinhard E. Voll has been medical director of the Department of Rheumatology and Clinical Immunology at University Medical Center Freiburg since 2010 and is recognised by the German Society for Immunology (DGfI) as a clinical immunologist. Prof. Dr. med. Martin Aringer is a rheumatologist and deputy clinic director at University Hospital Carl Gustav Carus Dresden.
Prof. Dr. Tobias B. Huber is director of the clinic for nephrology and rheumatology at University Medical Center Hamburg-Eppendorf, which is relevant when the kidneys are involved. University Hospital Erlangen has a Department of Medicine 3 – Rheumatology and Immunology and a Department of Medicine 4 – Nephrology.
Frequently asked questions
Can lupus be cured completely?
No, systemic lupus erythematosus cannot be cured completely at present: it is a chronic disease. The aim of treatment is to bring it into a calm phase, or at least to low activity, to protect the kidneys and other organs, and to manage with the lowest possible dose of cortisone. Flares can return after long quiet spells, so check-ups continue even without symptoms.
Which doctor treats lupus?
Lupus is managed by a rheumatologist, who confirms the diagnosis, prescribes the basic treatment and monitors disease activity. If the kidneys are involved, the rheumatologist works with a nephrologist; a neurologist sees patients with neurological symptoms, and pregnancy is planned with a gynaecologist.
Can I get pregnant if I have lupus?
Yes, pregnancy is possible with lupus, but it is planned in advance, ideally for a calm phase of the disease. Some drugs are stopped or replaced with pregnancy-compatible ones before conception. Antiphospholipid antibodies are checked beforehand because they raise the risk of blood clots. The rheumatologist and the gynaecologist look after the pregnancy together.
Is CAR-T cell therapy part of lupus treatment in Germany?
Only within clinical studies and under strict selection criteria. The first data come from the team at University Hospital Erlangen, in patients with severe lupus that had not responded to other drugs. It is not yet a standard treatment: doctors select the study participants, and it cannot be prescribed at a patient’s request.
How AlenMed arranges lupus treatment in Germany
AlenMed starts with the documents: antibody and complement results over time, urine tests, biopsy reports and a list of all drugs with doses and how long they were taken, including cortisone. We translate everything into German.
The hospital is chosen according to which organs are involved. We book the appointment, obtain the cost estimate and arrange the invitation letter for the visa, accommodation and an interpreter. AlenMed’s office is in Munich.
Lupus is a long-term disease, so the plan continues after the visit: the patient receives a report for the doctor at home, and follow-up is possible by video consultation.
This material is for information only and is not an offer. The treatment plan is decided by a doctor at an in-person appointment.