From the Guidelines
Diagnosis of systemic lupus erythematosus (SLE) requires a combination of laboratory tests and clinical evaluation, with initial diagnostic workup including antinuclear antibody (ANA) testing, anti-double-stranded DNA (anti-dsDNA), and anti-Smith (anti-Sm) antibodies, as well as complete blood count, comprehensive metabolic panel, urinalysis, complement levels, erythrocyte sedimentation rate, and C-reactive protein, as recommended by the European League Against Rheumatism (EULAR) 1.
Key Laboratory Tests
- Antinuclear antibody (ANA) testing: positive in over 95% of SLE patients
- Anti-double-stranded DNA (anti-dsDNA) and anti-Smith (anti-Sm) antibodies: more specific tests for SLE
- Complete blood count: to assess for anemia, leukopenia, and thrombocytopenia
- Comprehensive metabolic panel: to evaluate kidney and liver function
- Urinalysis: to assess for proteinuria and hematuria
- Complement levels (C3 and C4): to evaluate immune complex deposition
- Erythrocyte sedimentation rate and C-reactive protein: to assess for inflammation
Treatment and Management
Treatment depends on disease severity and organ involvement, with hydroxychloroquine (200-400 mg daily) serving as the foundation of therapy for all SLE patients, reducing flares and organ damage, as recommended by EULAR 1.
- For mild disease: hydroxychloroquine and NSAIDs like ibuprofen (400-800 mg three times daily) for joint pain and inflammation
- For moderate to severe disease: corticosteroids like prednisone (starting at 0.5-1 mg/kg/day with gradual tapering) for acute flares, and immunosuppressants like methotrexate, azathioprine, or mycophenolate mofetil as steroid-sparing agents
- For lupus nephritis: cyclophosphamide or mycophenolate mofetil are preferred, with biologics like belimumab or rituximab for severe refractory cases
Monitoring and Preventive Care
Regular monitoring of disease activity, medication side effects, and preventive care, including vaccinations, bone health assessment, and cardiovascular risk management, are crucial for optimal outcomes, as recommended by EULAR 1.
- Assessments every 6-12 months for patients with no activity, no damage, and no comorbidity
- Monitoring of autoantibodies and complement levels at baseline and during follow-up
- Screening for infection risk, osteoporosis, and cancer, and prevention of infections with inactivated vaccines.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnostic Tests for Systemic Lupus Erythematosus (SLE)
To diagnose SLE, several laboratory tests can be ordered, including:
- Complete blood picture to assess for anemia, leukopenia, or thrombocytopenia
- Liver function tests to evaluate for liver involvement
- Kidney function tests to assess for renal involvement
- Urine analysis to detect proteinuria or hematuria
- Antinuclear antibody (ANA) test to assess for the presence of autoantibodies
- Anti-double stranded DNA (anti-dsDNA) antibody test to evaluate for specific autoantibodies associated with SLE
- Complement levels (C3 and C4) to assess for complement activation
- Anti-C1q antibodies to evaluate for lupus nephritis 2
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to assess for inflammation, although their utility in diagnosing infections in SLE patients is limited 3
- Rheumatoid factor (RF) to assess for the presence of RF, which can be elevated in some SLE patients 4
Treatment Options for SLE
Treatment options for SLE depend on the severity of the disease and the organs involved. Some treatment options include:
- Immununosuppressive medications such as cyclophosphamide or mycophenolate to treat active nephritis
- Maintenance immunosuppression to prevent disease flare-ups
- Belimumab, a monoclonal antibody that targets B cells, to treat active SLE
- Novel anti-CD20 antibodies to deplete B cells
- Calcineurin inhibitors to treat active nephritis
- Treat-to-target strategy to achieve low-grade proteinuria (<700-800 mg/24 h) at 12-month post-induction 5