Systemic Lupus Erythematosus (SLE) Management

Diagnosis and Treatment

The European League Against Rheumatism recommends that SLE diagnosis be based on clinical findings with characteristic serological abnormalities, although it may be limited to one or several organs 1
The American College of Rheumatology suggests that SLE treatment aims to achieve remission or low disease activity and prevent flares in all organs, maintained with the lowest possible dose of glucocorticoids 1, 4
For lupus nephritis, therapy should aim for at least partial remission (defined as a reduction of proteinuria ≥50% to subnephrotic levels and serum creatinine within 10% of baseline) within 6-12 months 4

The European League Against Rheumatism recommends hydroxychloroquine (HCQ) for all SLE patients, unless contraindicated, with a dose not exceeding 5 mg/kg real body weight 1, 3
Glucocorticoids can be used with dose and administration route depending on the type and severity of organ involvement 1
Immunosuppressive agents, such as azathioprine, mycophenolate mofetil, and cyclosporin, can be considered for patients who do not respond to HCQ or glucocorticoids 5, 6

The European League Against Rheumatism suggests that first-line therapy for cutaneous lupus manifestations includes topical glucocorticoids and hydroxychloroquine 3
For hematologic manifestations, such as thrombocytopenia and autoimmune hemolytic anemia, initial therapy with pulse methylprednisolone intravenously is recommended 6
For antiphospholipid syndrome, low-dose aspirin can be considered for primary prevention of thrombosis and pregnancy loss 2, 3

Pregnancy can increase SLE disease activity, but flares are usually mild 2, 3
Patients with lupus nephritis and antiphospholipid antibodies have a higher risk of developing preeclampsia and should be closely monitored 2, 3
Prednisolone, azathioprine, hydroxychloroquine, and low-dose aspirin can be used during pregnancy in patients with SLE 2, 3

Regular monitoring of disease activity should be performed using validated activity indices 3
Biopsy, urinalysis, proteinuria, and renal function have independent predictive ability for clinical outcomes in lupus nephritis therapy 2, 3