Systemic Lupus Erythematosus Management

Systemic Lupus Erythematosus (SLE) Management

• Collaboration is crucial for SLE management, involving patients and healthcare teams. Nurses may collaborate with dietitians and physical therapists for patients with severe manifestations. Counselors can also help patients and caregivers manage stress.

Diagnosis

• SLE diagnosis relies on patient history, physical assessment, and lab studies.
• No single test confirms SLE in all cases.
• Autoantibodies cause abnormalities in lab tests.

Diagnostic Tests

• Anti-DNA antibody testing: Highly specific for SLE.
• Erythrocyte sedimentation rate (ESR): Typically elevated, potentially above 100 mm/hr.
• Serum complement levels: Usually decreased due to antigen-antibody complex formation.
• Complete Blood Count (CBC) abnormalities: Potential for anemia, leukopenia, lymphocytopenia, and thrombocytopenia.
• Urinalysis: May show proteinuria, hematuria, and blood cell casts during kidney involvement exacerbations.
• Renal function tests: (serum creatinine and blood urea nitrogen) assess renal disease extent.
• Kidney biopsy: May be performed for assess renal lesion severity and guide treatment.

Surgery

• No surgery for treating SLE directly.
• SLE may cause kidney damage, leading to end-stage renal disease requiring hemodialysis, peritoneal dialysis, or kidney transplant.

Pharmacologic Therapy

• Mild or remitting SLE: Often requires supportive care only. Aspirin or NSAIDs may manage symptoms like arthralgia, arthritis, inflammation, fever, fatigue. (Consider potential liver toxicity with aspirin). Low-dose corticosteroids (like prednisone) may also be beneficial.
• Topical corticosteroids: For skin lesions
• Oral contraceptives: Potentially trigger acute episodes, so may be avoided.
• Antimalarial drugs (e.g., hydroxychloroquine): Treat skin and arthritic manifestations. Reduce acute SLE episodes in mild to inactive disease. Use adjunctively in lupus nephritis. Monitor for retinal toxicity (6-month eye exams).
• Severe SLE: High-dose corticosteroid therapy (40-60 mg prednisone daily), tapered as tolerated. Long-term use possible. Monitor for various side effects (cushingoid effects, weight gain, hypertension, infection, osteoporosis, hypokalemia) and discuss the need for long-term management options.
• Severe manifestations requiring emergency management: (severe neurologic involvement, systemic vasculitis, thrombocytopenia, glomerulonephritis, or alveolar hemorrhage) may need high-dose IV corticosteroids and cytotoxic therapy.
• Belimumab (Benlysta): First FDA-approved SLE drug. Reduces B lymphocyte activity. Given intravenously or subcutaneously.
• Immunosuppressive agents: Increased risk of infection, malignancy, bone marrow depression and drug-specific toxicities

Nonpharmacologic Therapy

• Smoking cessation: crucial, as it exacerbates cardiovascular risks and increases infection susceptibility.
• Consult HCP: Before immunizations during infection/suspected infection.
• Healthy diet: Encouraged. Oily fish may offer cardiovascular protection.
• Herbal supplements and vitamins: Consult HCP before adding to diet, as some can have undesirable or lupus flare-up effects.
• Stress reduction: Important for managing SLE symptoms and overall quality of life. Peer mentoring can be helpful.