From the Guidelines
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that requires a comprehensive treatment approach, focusing on remission or low disease activity, and prevention of flares, with hydroxychloroquine recommended for all patients at a dose not exceeding 5 mg/kg real body weight 1.
Overview of SLE
Lupus is a chronic autoimmune disease where the immune system attacks healthy tissues and organs, affecting multiple body systems including the skin, joints, kidneys, brain, heart, lungs, and blood cells. The body essentially creates antibodies that attack its own cells, causing inflammation, tissue damage, and pain. Lupus affects people differently, with symptoms ranging from mild to severe, and often fluctuating between periods of flares and remission.
Diagnostic Criteria
Diagnosis typically involves a combination of:
- Blood tests (including antinuclear antibody test, anti-dsDNA, and complement tests)
- Urine tests
- Sometimes tissue biopsies
- A thorough evaluation of symptoms No single test can definitively diagnose lupus, so doctors look for at least 4 out of 11 common criteria established for the disease.
Treatment Options
Treatment focuses on managing symptoms and preventing flares. Medications include:
- NSAIDs like ibuprofen for pain and inflammation
- Antimalarials such as hydroxychloroquine (at a dose not exceeding 5 mg/kg real body weight) to manage skin issues and joint pain 1
- Corticosteroids like prednisone for inflammation during flares, with the goal of minimizing their use to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawing them 1
- Immunomodulatory agents (methotrexate, azathioprine, mycophenolate) to expedite the tapering/discontinuation of glucocorticoids 1
- Belimumab for persistently active or flaring extrarenal disease, and rituximab for organ-threatening, refractory disease 1
Lifestyle Modifications
Lifestyle modifications are equally important, including:
- Sun protection (as UV exposure can trigger flares)
- Regular exercise
- Adequate rest
- Stress management
- Avoiding smoking Regular medical follow-ups are essential to monitor disease activity and medication side effects, as treatment plans often need adjustment over time. The goal of treatment is to improve long-term patient outcomes, aiming at remission of disease symptoms and signs, prevention of damage accrual, and minimization of drug side-effects, as well as improvement of quality of life 1.
From the FDA Drug Label
Systemic Lupus Erythematosus (SLE) is a clinical diagnosis according to American College of Rheumatology classification criteria The patients had biopsy-proven lupus nephritis Class III, IV, and/or V; and had active renal disease at screening requiring standard therapy The primary efficacy endpoint was Primary Efficacy Renal Response (PERR) at Week 104, defined as a response at Week 100 confirmed by a repeat measurement at Week 104 of the following parameters: urine protein:creatinine ratio (uPCR) ≤0.7 g/g and estimated glomerular filtration rate (eGFR) ≥60 mL/min/1. 73 m2 or no decrease in eGFR of >20% from pre-flare value Hydroxychloroquine sulfate tablets are indicated for the treatment of systemic lupus erythematosus in adults
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that can affect various parts of the body, including the kidneys, joints, skin, and other organs.
- Effects on the body: SLE can cause inflammation and damage to multiple organ systems, leading to a range of symptoms, including kidney damage, joint pain, and skin rashes.
- Diagnostic criteria: The diagnosis of SLE is based on the American College of Rheumatology classification criteria, which include a combination of clinical and laboratory findings, such as biopsy-proven lupus nephritis.
- Treatment options: Treatment for SLE may include medications such as belimumab and hydroxychloroquine, as well as standard therapy, including corticosteroids and immunosuppressive agents. The goal of treatment is to manage symptoms, prevent flares, and slow disease progression. 2 3
From the Research
Definition and Effects of Systemic Lupus Erythematosus (SLE)
- Systemic lupus erythematosus (SLE) is a complex autoimmune disease that can affect many organs, including the skin, joints, central nervous system, and kidneys 4.
- It is characterized by inflammation and immune-mediated injury to multiple organ systems, including the mucocutaneous, musculoskeletal, hematologic, and kidney systems 5.
- The disease can cause a range of symptoms, from mild rashes and arthritis to debilitating fever, fatigue, joint pain, and severe organ and/or life-threatening disease 6.
Diagnostic Criteria for SLE
- There are no uniformly accepted diagnostic criteria for SLE, but the 2019 European Alliance of Associations for Rheumatology (formerly the European League Against Rheumatism)/American College of Rheumatology classification criteria are estimated to be 96.1% sensitive and 93.4% specific for SLE 5.
- These classification criteria include both clinical factors, such as fever, cytopenia, rash, arthritis, and proteinuria, and immunologic measures, such as SLE-specific autoantibodies and low complement levels 5.
Treatment Options for SLE
- The primary goal of treatment is to achieve disease remission or quiescence, defined by minimal symptoms, low levels of autoimmune inflammatory markers, and minimal systemic glucocorticoid requirement while the patient is treated with maintenance doses of immunomodulatory or immunosuppressive medications 5.
- Hydroxychloroquine is standard of care for SLE and has been associated with a significant reduction in mortality 5.
- Treatments in addition to hydroxychloroquine are individualized, with immunosuppressive agents, such as azathioprine, mycophenolate mofetil, and cyclophosphamide, typically used for treating moderate to severe disease 7, 5.
- Newer therapies, such as belimumab, voclosporin, and anifrolumab, have been approved for use in SLE and may offer improved outcomes 7, 5.