From the Guidelines
Systemic lupus erythematosus (SLE) should be diagnosed using the American College of Rheumatology criteria, which requires at least 4 of 11 clinical and laboratory findings, and treated based on disease severity and organ involvement, with hydroxychloroquine as the foundation of therapy for mild SLE, and systemic corticosteroids and immunosuppressants for moderate to severe disease, as recommended by the 2019 update of the EULAR recommendations for the management of SLE 1.
Diagnostic Criteria
The diagnostic criteria for SLE include:
- Malar rash
- Discoid rash
- Photosensitivity
- Oral ulcers
- Arthritis
- Serositis
- Renal disorder
- Neurologic disorder
- Hematologic disorder
- Immunologic disorder
- Positive antinuclear antibody (ANA)
Treatment Options
Treatment options for SLE depend on disease severity and organ involvement, and may include:
- Hydroxychloroquine (200-400mg daily) for mild SLE
- NSAIDs for pain and inflammation
- Topical corticosteroids for cutaneous manifestations
- Systemic corticosteroids like prednisone (0.5-1mg/kg/day) for moderate to severe disease
- Immunosuppressants such as methotrexate (7.5-25mg weekly), azathioprine (1-2.5mg/kg/day), or mycophenolate mofetil (1-3g daily)
- Biologics like belimumab (10mg/kg IV monthly) or rituximab (375mg/m² weekly for 4 weeks) for severe organ-threatening disease
Preventive Care
Patients with SLE should receive preventive care including:
- Vaccinations
- Vitamin D supplementation
- Bone density monitoring when on long-term steroids
- Regular monitoring of disease activity through clinical assessment and laboratory tests
- Sun protection and cardiovascular risk management
Goals of Treatment
The goals of treatment for SLE are to:
- Control inflammation
- Prevent flares
- Minimize organ damage
- Improve quality of life
- Balance medication side effects, as recommended by the 2019 update of the EULAR recommendations for the management of SLE 1.
Note: The 2019 update of the EULAR recommendations for the management of SLE 1 is the most recent and highest quality study, and its recommendations should be prioritized in the treatment of SLE.
From the FDA Drug Label
1.3 Systemic Lupus Erythematosus Hydroxychloroquine sulfate tablets are indicated for the treatment of systemic lupus erythematosus in adults. 2.4 Dosage for Systemic Lupus Erythematosus in Adults The recommended dosage is 200 mg given once daily, or 400 mg given once daily or in two divided doses.
The diagnostic criteria for systemic lupus erythematosus (SLE) are not provided in the drug label.
- Treatment options for SLE include hydroxychloroquine sulfate tablets, with a recommended dosage of 200 mg given once daily, or 400 mg given once daily or in two divided doses 2.
From the Research
Diagnostic Criteria for Systemic Lupus Erythematosus (SLE)
- The 2019 European Alliance of Associations for Rheumatology (formerly the European League Against Rheumatism)/American College of Rheumatology classification criteria are used for diagnosing SLE, with an estimated 96.1% sensitivity and 93.4% specificity 3.
- The criteria include clinical factors such as fever, cytopenia, rash, arthritis, and proteinuria, as well as immunologic measures like SLE-specific autoantibodies and low complement levels 3.
- Diagnosis is often based on a combination of clinical manifestations, laboratory tests, and medical history, as the disease can affect multiple organ systems and present with a wide range of symptoms 4, 5.
Treatment Options for SLE
- The primary goal of treatment is to achieve disease remission or quiescence, with minimal symptoms and low levels of autoimmune inflammatory markers 3.
- Hydroxychloroquine is a standard treatment for SLE and has been associated with a significant reduction in mortality 3.
- Additional treatments may include immunosuppressive agents like azathioprine, mycophenolate mofetil, and cyclophosphamide for moderate to severe disease 3.
- Biologic therapies such as belimumab, voclosporin, and anifrolumab have been approved for the treatment of SLE and lupus nephritis 3.
- Lifestyle changes, such as avoiding ultraviolet light, and prevention of comorbidities like coronary artery disease and osteoporosis are also important aspects of SLE management 4.
Cutaneous Manifestations of SLE
- Cutaneous lupus erythematosus can be subdivided into three main categories: acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus 6, 7.
- Physical exam, laboratory studies, and histopathology are used to differentiate between cutaneous lupus subtypes, which is important for treatment and disease monitoring 7.
- Treatment options for cutaneous lupus include topical and systemic therapies, such as antimalarial drugs and corticosteroids 6, 7.