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
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