Management of patients with SLE

Question 1

What to consider when choosing treatment for lupus?

Answer 1

• Is it because of lupus or infection or co-morbidities
• is it active or from damage
• is it from treatment (side effects)

Question 2

What is lupus damage?

Answer 2

Irreversible damage to organs from previous active SLE or complications from treatment e.g. corticosteroids. for example pulmonary fibrosis, end-stage renal disease, osteoporosis, diabetes mellitus. Damage accumulation is associated with mortality and won’t respond to immunosuppression

Question 3

Factors associated with damage?

Answer 3

• African/caribbean background
• renal/ neurological disease activity
• Treatment with steroids and immunosuppresants
• Presence of anti-RNP and anti-phospholipids

Question 4

What is treatment strategy for lupus?

Answer 4

• Lifestyle change
• Managing co-morbidities
• For mild disease some topical agents can be used.
• If patient has no major organ involvement, antimalarials. low-dose steroids or methotrexate can be used. - If there is major organ involvement then cyclophosphamide, calcineurin inhibitors, rituximab or belimumab or being enrolled in clinical trials

Question 5

What is management for SLE?

Answer 5

• SPF and sun avoidance
• Supplementation of vitamin D
• Contraception
• Diet
• Exercise
• Smoking
• Infection management

Question 6

Reproductive issues and SLE?

Answer 6

• Miscarriages very likely
• Fetal growth restriction
• Lupus flare in pregnancy and post-partum
• Premature menopause