From the Guidelines
Systemic Lupus Erythematosus (SLE) symptoms can be managed with a treatment approach that aims at remission or low disease activity and prevention of flares in all organs, maintained with the lowest possible dose of glucocorticoids, as recommended by the 2019 EULAR guidelines 1. The symptoms of SLE vary widely among patients and can affect multiple body systems, including:
- Extreme fatigue
- Joint pain and swelling
- Butterfly-shaped rash across the cheeks and nose
- Skin lesions that worsen with sun exposure
- Fever
- Hair loss
- Raynaud's phenomenon (fingers turning white or blue in cold temperatures)
- Chest pain during deep breathing
- Headaches
- Cognitive issues sometimes called "lupus fog" SLE can also cause:
- Kidney problems (lupus nephritis)
- Blood disorders like anemia or low platelet counts
- Inflammation of the heart or lungs Symptoms typically come and go in periods called flares, which can be triggered by sunlight, infections, certain medications, or stress. The treatment of SLE should be individualized and based on the severity of organ involvement, with the goal of achieving remission or low disease activity and preventing flares, as recommended by the 2019 EULAR guidelines 1. The use of hydroxychloroquine (HCQ) is recommended for all patients with SLE, unless contraindicated, at a dose not exceeding 5 mg/kg/real body weight, as recommended by the 2019 EULAR guidelines 1. Glucocorticoids can be used at doses and routes of administration that depend on the type and severity of organ involvement, with the goal of minimizing the dose to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawing them, as recommended by the 2019 EULAR guidelines 1. Immunosuppressive therapies, such as methotrexate, azathioprine, or mycophenolate, can be used in patients who do not respond to HCQ or glucocorticoids, or who require high doses of glucocorticoids, as recommended by the 2019 EULAR guidelines 1. Biologics, such as belimumab, can be used in patients with inadequate response to standard-of-care therapies, as recommended by the 2019 EULAR guidelines 1. The management of neuropsychiatric manifestations of SLE should be based on the attribution of the manifestation to SLE, and should include the use of glucocorticoids and immunosuppressive therapy for manifestations that reflect an inflammatory process, and antiplatelet/anticoagulation therapy for manifestations related to antiphospholipid antibodies, as recommended by the 2010 EULAR guidelines 1.
From the Research
SLE Symptoms and Treatment
- Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that requires treatment with synthetic drugs to ameliorate symptoms and positively influence outcome 2
- The treatment of SLE often involves the use of glucocorticoids, such as prednisone, to reduce disease activity and prevent flares 3, 4, 5
- However, high doses of glucocorticoids can lead to damage and side effects, such as cataracts, osteonecrosis, osteoporotic fractures, and diabetes mellitus 3, 5
- Studies have shown that lower doses of prednisone (≤30 mg/day) are similarly effective and safer than higher doses for treating active lupus 3
- The use of immunosuppressants, such as azathioprine, mycophenolate mofetil, and methotrexate, can help reduce the need for glucocorticoids and minimize damage 4, 6
- Hydroxychloroquine is considered an anchor drug in SLE treatment due to its multiple beneficial effects, and should be used in combination with other medications to achieve optimal outcomes 2, 6
Disease Management and Outcomes
- The goal of SLE treatment is to stop all disease activity without long-term use of more than 5 mg prednisolone per day, and to achieve remission 6
- Patients with SLE require regular monitoring and adjustment of treatment to prevent flares and minimize damage 4, 5
- The use of vaccinations and control of risk factors for atherosclerosis are critical for long-term survival in patients with SLE 6
- Novel approaches and new drugs are being tested in controlled trials to improve treatment outcomes for patients with SLE 6