Systemic Lupus Erythematosus Diagnosis and Management

Diagnosis

The American College of Rheumatology recommends that SLE diagnosis should be based on a combination of characteristic clinical findings and serological abnormalities, with particular attention to multi-organ involvement patterns that affect mortality and quality of life 1, 2
Clinical manifestations to evaluate include skin lesions, arthritis, serositis, and neurological manifestations 1, 2
Laboratory tests essential for diagnosis include complete blood count, renal function, and immunological markers 1, 3, 4, 5

The European League Against Rheumatism recommends hydroxychloroquine for all SLE patients unless contraindicated, as it reduces flares, increases remission rates, and reduces organ damage even in lupus nephritis 1, 6
Glucocorticoids should be used at the lowest effective dose, with a target of less than 7.5 mg/day prednisone equivalent for maintenance 6
Methotrexate may be considered for patients with predominant articular and cutaneous manifestations 1, 6

For mild to moderate SLE without major organ involvement, hydroxychloroquine and low-dose glucocorticoids are recommended 6
For moderate to severe SLE with major organ involvement, mycophenolate mofetil or low-dose intravenous cyclophosphamide combined with glucocorticoids may be considered 6

For cutaneous manifestations, first-line treatment includes topical glucocorticoids and hydroxychloroquine 1
For lupus nephritis, the goal is to achieve at least partial remission within 6-12 months, and treatment with mycophenolate mofetil or cyclophosphamide plus glucocorticoids may be considered 2
For neuropsychiatric lupus, immunosuppressive therapy and anticoagulation may be necessary 2, 3

Regular assessment and management of atherosclerosis risk factors are recommended, and low-dose aspirin may be considered for primary prevention in patients with antiphospholipid antibodies 2, 5, 1, 6
High index of suspicion for infections, prompt evaluation, and diligent follow-up are necessary, and vaccination according to guidelines is recommended 1, 5
Monitoring and prevention of osteoporosis and avascular necrosis are important, and calcium and vitamin D supplementation may be necessary 1, 6

Pregnancy can increase SLE disease activity, and patients with lupus nephritis and antiphospholipid antibodies have a higher risk of preeclampsia 2
Safe medications during pregnancy include prednisolone, azathioprine, hydroxychloroquine, and low-dose aspirin, while mycophenolate mofetil, cyclophosphamide, and methotrexate should be avoided 1, 2

Regular monitoring of disease activity using validated indices, such as BILAG, ECLAM, or SLEDAI, is recommended 1
Monitoring of clinical manifestations, laboratory tests, and immunological markers is necessary, and regular assessment of proteinuria, urinary sediment, and renal function is important for lupus nephritis 1, 2, 6