systemic%20lupus%20erythematosus
SYSTEMIC LUPUS ERYTHEMATOSUS
Systemic lupus erythematosus is a chronic, multisystem, inflammatory, autoimmune disorder characterized by formation of autoantibodies directed against self-antigens and immune-complex formation.
It can be suspected when ≥2 organ systems are involved.
It is predominantly diagnosed in females of childbearing age, rarely diagnosed before 8 years old.
Clinical presentation varies in different patients and the disease activity varies over time in a single patient. Majority of patients have arthralgia of the hand.

Monitoring

Lifelong monitoring is required for systemic lupus erythematosus (SLE) patients. Frequency of visits depends on disease activity, severity & extent; response to treatment, type of treatment & monitoring of toxicity
  • The most important tool in the management of SLE is careful, frequent clinical & laboratory evaluation to detect disease flares, appearance of infections & to tailor management based on patient response
    • Do active surveillance of opportunistic infections
  • Physicians may be aided by at least 1 of the following several global or body system specific indices developed for long-term observation of SLE
    • British Isles Lupus Assessment Group (BILAG)
    • European Consensus Lupus Activity Measure (ECLAM)
    • Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)
  • Patients w/ severe SLE, complications & toxicity will require more frequent follow-up
  • Monitoring during clinic visit should include:
    • History-taking
    • Physical exam
    • Laboratory tests
      • Complete blood count (CBC)
      • Creatinine measurement
      • Urinalysis
  • Results of laboratory tests that may precede a disease flare:
    • Decrease in serum complement levels
    • Increase in anti-dsDNA
    • Increase in erythrocyte sedimentation rate (ESR)
    • Decrease in hemoglobin level, leukocyte or platelet counts
    • Increase in creatine phosphokinase (CPK) levels
    • Appearance of microscopic hematuria or proteinuria

Expert Referral

  • Establish good working relationship amongst the primary care physician, pediatrician, rheumatologist, nurse, pharmacist, other healthcare providers, the patient & his/her family
    • Team approach will allow for earlier identification of disease flares & medication toxicity
  • Patient will initially present to a primary care physician/pediatrician who is responsible for:
    • Recognizing the signs & symptoms of systemic lupus erythematosus (SLE) in their patients
    • Making an initial diagnosis
    • Managing & monitoring patients w/ mild & stable SLE
    • Referring patient to a rheumatologist & participating in further SLE diagnosis, management & monitoring
  • A rheumatologist is an integral part of the medical team managing an SLE patient
  • Referral to a rheumatologist is indicated for:
    • Confirmation of diagnosis
    • Management plan for patient
    • Periodic evaluation of disease activity & severity
    • Management of uncontrolled disease
    • Management of organ involvement or life-threatening disease
    • Prevention &/or management of treatment toxicities
    • Special situations (eg pregnancy, antiphospholipid syndrome, life-threatening disease, concomitant infection & surgery)
  • SLE patients should be referred to a psychologist, psychiatrist, physical &/or occupational therapist, ophthalmologist, dermatologist, nephrologist, cardiologist, orthopedic surgeon & other specialists when necessary
    • If there are signs of renal involvement, patient should be referred to a nephrologist for management
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Rheumatology digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Pearl Toh, 5 days ago
A study finds no evidence that using pharmaceutical aids alone for smoking cessation helps improve the chances of successful quitting despite promising results in previous randomized trials and routine prescription of such drugs to help quit smoking.
Elvira Manzano, 2 days ago
Cancer patients at risk for recurrent venous thromboembolism (VTE) are less likely to experience recurrence with rivaroxaban compared with dalteparin, the Select-D trial has shown, ushering in a new standard of care (SoC) for cancer-related VTE.
Yesterday
Weight loss medications that have received the Food and Drug Administration (FDA) approval appear to confer only modest positive benefits for cardiometabolic risk profile, according to a study.
2 days ago
The risk of stroke and subsequent mortality is significantly elevated in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD), a recent study has shown.