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Questions and Answers
What is a commonly used regimen for severe and life-threatening systemic lupus erythematosus (SLE)?
What is the recommended sun protection factor for patients with systemic lupus erythematosus (SLE) to use?
What has been shown to be effective in patients with active SLE who have responded inadequately to standard therapy?
What is the risk associated with cyclophosphamide in the treatment of severe systemic lupus erythematosus (SLE)?
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Which medication has been used successfully with high-dose glucocorticoids for renal involvement in SLE?
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What is the typical maintenance regimen for SLE patients following control of acute disease?
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What is the long-term aim for SLE patients in terms of glucocorticoid and immunosuppressant therapy?
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What is recommended for SLE patients with the antiphospholipid antibody syndrome, who have had previous thrombosis?
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What are SLE patients at risk of, and should be screened for accordingly?
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Which medication has been reported as effective in selected cases for SLE, despite randomised controlled trials not showing significant overall efficacy?
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What is the recommended approach for controlling cardiovascular risk factors in SLE patients?
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What should be considered prior to treatment with cyclophosphamide due to the risk of azoospermia and premature menopause?
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Patients should be advised to avoid ______ and ultraviolet light exposure
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The monoclonal antibody belimumab, which targets the β-cell growth factor BLyS, has recently been shown to be effective in patients with active SLE who have responded inadequately to standard ______
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High-dose glucocorticoids and ______ are required for the treatment of renal, CNS and cardiac involvement
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Cyclophosphamide may cause haemorrhagic cystitis but the risk can be minimised by good hydration and co-prescription of mesna (2-mercaptoethane sulfonate), which binds its urotoxic ______
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Following control of acute disease, a typical maintenance regimen is oral prednisolone in a dose of 40–60 mg daily, gradually reducing to 10–15 mg/day or less by 3 months. Azathioprine (2–2.5 mg/kg/day), methotrexate (10–25 mg/week) or MMF (2–3 g/day) should also be prescribed. The long-term aim is to continue the lowest dose of glucocorticoid and immunosuppressant to maintain ______.
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Patients with SLE and the antiphospholipid antibody syndrome, who have had previous thrombosis, require life-long ______ therapy.
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SLE patients are at risk of osteoporosis and hypovitaminosis D, and should be screened with biochemistry and DXA scanning ______.
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Belimumab in combination with standard therapy significantly decreases disease activity in SLE patients and is safe and well ______.
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Rituximab has been reported as being effective in selected cases, though randomised controlled trials have not shown significant overall ______.
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Because of the risk of azoospermia and premature menopause, sperm or oöcyte collection and storage need to be considered prior to treatment with ______.
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MMF has been used successfully with high-dose glucocorticoids for renal involvement with results similar to those of pulsed cyclophosphamide but fewer adverse ______.
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Cardiovascular risk factors, such as hypertension and hyperlipidaemia, should be controlled and patients should be advised to stop ______.
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Study Notes
Therapeutic Goals
- Educate patients about the nature of the illness
- Control symptoms
- Prevent organ damage and maintain normal function
Lifestyle Modifications
- Avoid sun and ultraviolet light exposure
- Use sun blocks with a sun protection factor of 25-50
Management of Mild to Moderate Disease
- Use analgesics, NSAIDs, and hydroxychloroquine
- May require glucocorticoids (prednisolone 5-20 mg/day) and immunosuppressants (methotrexate, azathioprine, or MMF)
Management of Severe and Life-Threatening Disease
- Use high-dose glucocorticoids and immunosuppressants for renal, CNS, and cardiac involvement
- Pulsed methylprednisolone (10 mg/kg IV) plus cyclophosphamide (15 mg/kg IV) is a commonly used regimen
- Cyclophosphamide may cause haemorrhagic cystitis, but risk can be minimized with good hydration and co-prescription of mesna
- Consider sperm or oöcyte collection and storage prior to treatment with cyclophosphamide
Alternative Therapies
- Belimumab targets the β-cell growth factor BLyS and is effective in patients with active SLE who have responded inadequately to standard therapy
- MMF has been used successfully with high-dose glucocorticoids for renal involvement
- Rituximab has been reported as effective in selected cases, but randomised controlled trials have not shown significant overall efficacy
Maintenance Therapy
- Typical maintenance regimen is oral prednisolone (40-60 mg daily) with gradual reduction to 10-15 mg/day or less by 3 months
- Azathioprine (2-2.5 mg/kg/day), methotrexate (10-25 mg/week), or MMF (2-3 g/day) should also be prescribed
- Long-term aim is to continue the lowest dose of glucocorticoid and immunosuppressant to maintain remission
Additional Considerations
- Control cardiovascular risk factors (hypertension, hyperlipidaemia)
- Advise patients to stop smoking
- Patients with SLE and antiphospholipid antibody syndrome require life-long warfarin therapy
- Patients are at risk of osteoporosis and hypovitaminosis D, and should be screened with biochemistry and DXA scanning accordingly
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Description
Test your knowledge of managing and treating a specific illness, including educating patients about their condition, controlling symptoms, preventing organ damage, and maintaining normal function. Topics covered include advising patients to avoid sun exposure, using sun protection and managing mild to moderate disease that affects the skin and joints.
