From the Guidelines
Patients with Systemic Lupus Erythematosus (SLE) should be admitted to the hospital when they experience severe or life-threatening disease flares that require intensive monitoring or treatment, such as severe organ involvement, infections, or failure of outpatient management. When considering hospital admission for SLE patients, it is crucial to assess the severity of the disease flare and the presence of any life-threatening manifestations. According to the 2019 update of the EULAR recommendations for the management of SLE 1, treatment aims at remission or low disease activity and prevention of flares. However, in cases of severe or life-threatening flares, hospital admission is necessary to provide intensive monitoring and treatment. Some key indications for hospital admission include:
- Severe organ involvement, such as acute kidney injury with rising creatinine, neuropsychiatric lupus with seizures or altered mental status, severe thrombocytopenia (platelets <20,000), hemolytic anemia requiring transfusion, pulmonary hemorrhage, cardiac involvement (myocarditis, pericardial tamponade), or severe serositis
- Infections complicating the flare
- Inability to take oral medications due to severe gastrointestinal involvement
- Failure of outpatient management Treatment for severe SLE flares typically involves high-dose intravenous corticosteroids, followed by oral prednisone, along with immunosuppressants depending on the specific organ involvement, as recommended by the EULAR guidelines 1. Hospital admission allows for close monitoring of vital signs, laboratory parameters, and response to therapy while managing complications and providing supportive care if needed.
From the FDA Drug Label
The proportion of patients reporting at least 1 severe flare during the study was lower in patients treated with BENLYSTA plus standard therapy (11%) compared with those receiving placebo plus standard therapy (18%) Patients treated with BENLYSTA plus standard therapy had a 49% lower risk of experiencing at least 1 severe flare during the 52 weeks of observation, relative to the patients receiving placebo plus standard therapy (HR = 0.51 [95% CI: 0.35,0. 74]).
The FDA drug label does not answer the question.
From the Research
Hospital Admission for SLE Disease Flare
A patient with Systemic Lupus Erythematosus (SLE) may require hospital admission due to a disease flare in the following situations:
- Severe lupus nephritis, as indicated by a significant increase in proteinuria, decrease in complement levels, and active urinary sediments 2
- Neurological involvement, such as seizures, psychosis, or cerebral vasculitis, which can be life-threatening and require immediate medical attention 2, 3
- Inadequate response to standard therapy, including immunosuppressive regimens, which may necessitate alternative treatments such as combined mycophenolate mofetil and tacrolimus 4
- Presence of severe adverse events, such as major infections, which can occur during treatment with immunosuppressive agents 2, 4
Key Indicators for Hospital Admission
Some key indicators that may require hospital admission for an SLE patient include:
- Significant deterioration in renal function, as evidenced by increased creatinine levels or decreased complement levels 2, 4
- Active lupus serology, including high levels of anti-dsDNA antibodies 4
- Presence of neurological symptoms, such as seizures or psychosis, which can be indicative of a severe disease flare 3
- Inability to manage symptoms or disease activity in an outpatient setting, which may require more intensive medical care and monitoring 5, 6