Clinical management of systemic lupus erythematosus.pptx

Clinical management of systemic lupus erythematosus

1. Clinical management of systemic lupus erythematosus

2. Initial and ongoing management Hydroxychloroquine: Recommended for all patients to prevent flares, reduce organ damage, and improve long-term survival. Patient education: Crucial for all patients to understand the disease, recognize flares, manage symptoms, adhere to treatment, and identify and minimize triggers. Lifestyle: Encourage sun protection, especially for those with photosensitive rashes. Monitoring: All patients need ongoing clinical and laboratory monitoring for disease activity, organ damage, and complications.

3. Pharmacologic therapy based on severity Mild disease: Management may be shared between primary care and rheumatology. Moderate to severe disease: Corticosteroids: High-dose corticosteroids are often used for severe flares. Immunosuppressants: Used when disease is severe, affects major organs (kidneys, nervous system), or does not respond to corticosteroids. Commonly used immunosuppressants: Mycophenolate mofetil Azathioprine (often for maintenance) Cyclophosphamide (often used for severe induction therapy, with short courses due to toxicity) Rituximab (in some cases)

4. Other medications Blood thinners: For complications like antiphospholipid syndrome. Methotrexate: Can be effective for musculoskeletal and mucocutaneous involvement.

5. Specific populations and considerations Pregnancy: Preconception counseling: Essential for all women of reproductive age. Management: Continue hydroxychloroquine, azathioprine, low-dose corticosteroids, and calcineurin inhibitors as appropriate. Low-dose aspirin: Initiate in pregnant SLE patients unless contraindicated. Infection: Patients with SLE are at higher risk for infection, so early identification and treatment are critical. Cardiovascular risk: Screen for and manage cardiovascular risk factors and osteoporosis. Vaccinations: Assess and update vaccination status annually.

6. Monitoring and assessment Clinical monitoring: Track disease activity and flares. Laboratory monitoring: Routine labs: Urine, blood pressure, blood chemistry, and lipid profiles. Inflammatory markers: Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP). Antibody tests: Antinuclear Antibody (ANA), anti-double-stranded DNA, and anti-Smith. Complement tests: C3 and C4.