What are the symptoms of Systemic Lupus Erythematosus (SLE)?

From the Guidelines

Systemic lupus erythematosus (SLE) symptoms should be managed with the goal of achieving remission or low disease activity, and preventing flares, using a combination of glucocorticoids, immunomodulating agents, and biologics, as recommended by the 2019 EULAR guidelines 1. The management of SLE symptoms involves a multi-faceted approach, considering the varying severity and organ involvement of the disease.

• Treatment goals include achieving remission or low disease activity, and preventing flares, in all organs, while minimizing the use of glucocorticoids 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 1.
• Glucocorticoids (GC) can be used at doses and routes of administration that depend on the type and severity of organ involvement, with the aim of minimizing chronic maintenance treatment to less than 7.5 mg/day (prednisone equivalent) 1.
• Immunomodulating/immunosuppressive agents, such as methotrexate, azathioprine, or mycophenolate, can be added to the treatment regimen in patients not responding to HCQ or GC, or in cases of organ-threatening disease 1.
• Biologics, such as belimumab, can be considered in patients with inadequate response to standard-of-care treatments, defined as residual disease activity not allowing tapering of glucocorticoids and/or frequent relapses 1. The 2019 EULAR guidelines provide a comprehensive framework for the management of SLE symptoms, emphasizing the importance of individualized treatment approaches and regular monitoring to optimize outcomes 1.
• Specific manifestations of SLE, such as skin disease, neuropsychiatric disease, hematological disease, and renal disease, require tailored treatment approaches, taking into account the severity and organ involvement of the disease 1.
• Early recognition of signs of renal involvement and performance of a diagnostic renal biopsy are essential to ensure optimal outcomes in patients with renal disease 1.
• Mycophenolate or low-dose intravenous cyclophosphamide are recommended as initial treatment for renal disease, with mycophenolate or azathioprine used for maintenance therapy 1.

From the Research

SLE Symptoms

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by inflammation and immune-mediated injury to multiple organ systems, including the mucocutaneous, musculoskeletal, hematologic, and kidney systems 2
• Clinical manifestations of SLE include fever, cytopenia, rash, arthritis, and proteinuria, which may be indicative of lupus nephritis 2
• Approximately 40% of people with SLE develop lupus nephritis, and an estimated 10% of people with lupus nephritis develop end-stage kidney disease after 10 years 2
• SLE can affect every organ and tissue, and the pattern of organ involvement is widely heterogeneous, reflecting the complex mosaic of disrupted molecular pathways converging into the SLE clinical phenotype 3

Common Symptoms

• Mucocutaneous symptoms: rash, skin lesions
• Musculoskeletal symptoms: arthritis, joint pain
• Hematologic symptoms: cytopenia, anemia
• Kidney symptoms: proteinuria, lupus nephritis
• Other symptoms: fever, fatigue, weight loss 2, 3, 4

Diagnosis and Treatment

• The 2019 European Alliance of Associations for Rheumatology (formerly the European League Against Rheumatism)/American College of Rheumatology classification criteria are used to diagnose SLE 2
• Treatment goals include reducing disease exacerbations, hospitalizations, and organ damage due to the disease or treatment toxicity 2
• Hydroxychloroquine is the standard of care for SLE and has been associated with a significant reduction in mortality 2
• Other treatments include immunosuppressive agents, such as azathioprine, mycophenolate mofetil, and cyclophosphamide, as well as biologic therapies, such as belimumab, voclosporin, and anifrolumab 2, 5