What is Systemic Lupus Erythematosus (SLE)?

From the Guidelines

Systemic Lupus Erythematosus (SLE) is a chronic multi-organ autoimmune disease characterized by immune complex deposition and vasculopathy, affecting any organ and tissue of the human body, with a complex interplay between genetic susceptibility and environmental factors. The disease is more common among women, with an estimated prevalence of 20 to 150 cases per 100,000 population 1. Key characteristics of SLE include:

• Clinical heterogeneity
• Higher risk of infections, particularly bacterial infections, which account for 25-50% of overall mortality
• Immune system dysregulation, with dysregulation of type-1 interferon being a common denominator
• Genetic predisposition and environmental triggers contributing to the development of the disease Some of the key points to consider in SLE include:
• The importance of vaccination, particularly against Streptococcus pneumoniae, which is a common cause of morbidity and mortality in SLE patients 1
• The use of hydroxychloroquine, corticosteroids, and immunosuppressants in the management of SLE, as recommended by the European League Against Rheumatism (EULAR) 1
• The need for regular medical follow-ups and monitoring for signs of flares, such as joint pain, rash, or fatigue
• The importance of protecting oneself from sun exposure, which can trigger SLE flares It is essential to note that SLE is a complex disease, and its management requires a comprehensive approach, taking into account the individual patient's needs and disease characteristics. The primary goal of treatment in SLE is to achieve remission or low disease activity, while minimizing the risk of flares and preventing organ damage. This can be achieved through a combination of medications, including hydroxychloroquine, corticosteroids, and immunosuppressants, as well as lifestyle modifications, such as protecting oneself from sun exposure and maintaining regular medical follow-ups. In terms of specific treatments, hydroxychloroquine is recommended for all patients with SLE, unless contraindicated, at a dose not exceeding 5 mg/kg real body weight 1. Additionally, corticosteroids should be minimized to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn 1. Immunosuppressants, such as methotrexate, azathioprine, or mycophenolate, may also be used to manage SLE, particularly in patients with moderate to severe disease. Belimumab, a biologic medication, may be added for patients with active disease despite standard therapy 1. Overall, the management of SLE requires a comprehensive and individualized approach, taking into account the patient's unique needs and disease characteristics.

From the Research

Definition and Overview of Systemic Lupus Erythematosus (SLE)

• Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease that can be severe and potentially life-threatening 2.
• It is characterized by a heterogeneous organ manifestation, making it a therapeutic challenge 2.
• SLE is an autoimmune disease where the body's immune system attacks its own tissues, leading to inflammation and damage in various parts of the body.

Symptoms and Treatment

• The disease poses a challenge for physicians in determining the appropriate drug(s) to prescribe for each patient due to its highly variable and unpredictable course 3.
• Synthetic drugs, such as hydroxychloroquine, glucocorticoids, and immunosuppressants, are the mainstay of therapy in SLE 3.
• Hydroxychloroquine is considered an anchor drug in SLE due to its multiple beneficial effects, including preventing disease flares and damage accrual 3, 4.
• Biological agents, such as belimumab, are recommended when other treatment options have failed due to intolerance or inefficacy 5, 2.

Treatment Options and Efficacy

• Several synthetic drugs, including azathioprine and mycophenolate mofetil, have been evaluated for their efficacy and safety in SLE treatment 3.
• Epratuzumab, a humanized IgG1 monoclonal antibody, has been considered a potential treatment for SLE, but its efficacy is still being researched 6.
• Hydroxychloroquine has been shown to have a protective effect on survival in patients with SLE, even after adjusting for confounding factors 4.