/ After training in internal medicine at Massachusetts General Hospital, Boston, she completed fellowships in rheumatology, and allergy and immunology at the University of California, San Francisco, School of Medicine. Ferreira Neves Neto J, Am Fam Physician. 35. Although guidelines do not address this need, patients with SLE may benefit from treatment with a statin because of their increased 10-year risk of a cardiovascular event.47,48 Blood pressure should also be treated to a goal similar to that for patients with comorbid conditions such as diabetes (less than 140/90 mm Hg).44,45,47,49, Lung involvement in SLE can vary from minor pleuritic pain in serositis to life-threatening complications such as alveolar hemorrhage.50 Pleuritis occurs in 17% to 60% of patients with SLE.50,51 Treatment is based on the type and severity of lung involvement, and may include glucocorticoids, immunosuppressive agents, and plasmaphersis.32,52. Spence D, Hahn BH, et al. Berra K, 1. Joint Pain and Fatigue: It Could Be Anything, https://www.aafp.org/afp/recommendations/search.htm. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Jinnah R, Del Pino-Sedeño T, The last published guidelines … Marchand-Adam S, Bertsias GK, Satoh M, Guidelines for referral and management of systemic lupus erythematosus in adults. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. del Carmen Cravioto M. Manifestations of systemic lupus erythematosus. Retinopathy as a result of hydroxychloroquine use is usually reversible when the drug is discontinued. Mosca L, Guidelines have been developed to help improve the management of SLE patients, but there has been no formal evaluation of these guidelines. UVA = ultraviolet A; UVB = ultraviolet B; G6PD = glucose-6-phosphate dehydrogenase. Dallal GE, Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Systemic lupus erythematosus is more common in blacks than in whites and is obviously more common in women than in men (ratio: 9:1).3 Fessel WJ. Katzap E. SLE is a multi-system autoimmune disease that is characterised by mostly chronic inflammatory effects on a variety of organs. et al. Fries JF, Diot P, Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Kwon N. Once SLE is suspected, the initial evaluation should include an antinuclear antibody (ANA) test.15 This is a highly sensitive test, with positive results in about 94% of patients with SLE.15 SLE is unlikely in a patient with negative results. At some point, over 90 percent of patients with systemic lupus erythematosus have polyarthralgias or polyarthritis because of the disease. Want to use this article elsewhere? et al. 9th ed. Medicine for the practicing physician. Ioannidis JP, The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis. Incidence, prevalence, outcome, and first symptoms; the high prevalence in black women. Bertsias GK, Compared with an age-matched group in the Framingham cohort, women 35 to 44 years of age who had SLE had a greatly increased risk of myocardial infarction (rate ratio = 52; 95% confidence interval, 22 to 98).42 The increased risk of accelerated atherosclerosis suggests that there are other SLE-related factors, such as renal disease, cytokines, inflammatory mediators, antiphospholipid antibodies, oxidized low-density lipoprotein, and adverse effects of treatment, that cause accelerated cardiovascular disease.19,43 SLE is an independent risk factor for the development of atherosclerosis, and is identified as such by the American Heart Association.19,44, It is important to counsel patients to reduce traditional cardiovascular risk factors such as smoking and obesity, and to have routine screenings for diabetes mellitus, hypertension, and dyslipidemia. MMWR Morb Mortal Wkly Rep. Boivin JF, 2010;12(3):124. Patients with central nervous system manifestations of lupus erythematosus who present with status epilepticus, organic brain syndrome or coma can be treated with intravenous methylprednisolone pulse therapy. LUpus in MInority populations: NAture vs Nurture. Gordon C. Meilahn EN, Hughes GR. Hungerford D, Silosi I, ACR = American College of Rheumatology; ANA = antinuclear antibodies; anti-dsDNA = anti–double-stranded DNA antibodies; anti-Sm = anti-Smith antibodies; SLICC = Systemic Lupus International Collaborating Clinics. Tonner C, Cervera R, 9th ed. 2000;9(2):101–109. American College of Rheumatology Task Force on Osteoporosis Guidelines. Hochberg MC. ; Hale ED, Previous: Behavioral Disorders in Dementia: Appropriate Nondrug Interventions and Antipsychotic Use, Next: Failure to Thrive: A Practical Guide, Home et al. 10. Carter BL, Abrahamowicz M, Am J Reprod Immunol. Gill JM, The cause of systemic lupus erythematosus remains elusive. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Felson DT, Arthritis Rheum 1982; 25:1271–7. / The American College of Rheumatology has 11 classification criteria for lupus. 2009;2009:1123. Weisman MH, Risk for sustained amenorrhea in patients with systemic lupus erythematosus receiving intermittent pulse cyclophosphamide therapy. Cervera R, et al. The visceral organ most commonly involved in SLE is the kidney.18 Although almost all patients with SLE have immunoglobulin deposits in the glomeruli, only 50% develop clinical renal disease.22 Screening for nephritis with urinalysis and serum creatinine measurement should be done at three- to six-month intervals.8,33 When a patient with SLE has clinical or laboratory features that suggest nephritis, 24-hour urine testing for protein or a spot urine protein:creatinine ratio should be obtained.27 Referral for renal biopsy should be considered in patients with proteinuria of at least 1 g in 24 hours, or at least 0.5 g in 24 hours with hematuria or cellular casts. Tan EM, 10. Hellmann D, 5. LUpus in MInority populations: NAture vs Nurture. This study aims to compare the scope, quality, and consistency of clinical practice guidelines on the diagnosis, monitoring, and treatment of patients with SLE. The natural history of hypercholesterolaemia in systemic lupus erythematosus. Low dosages of methotrexate (Rheumatrex), such as 7.5 mg given orally once per week, are extremely effective. 2002;41(10):1095–1100. Philadelphia, Pa.: Saunders Elsevier; 2013:1304–1330. Arthritis Rheum 1982; 25:1271–7, NSAIDs = nonsteroidal anti-inflammatory drugs, UVA = ultraviolet A; UVB = ultraviolet B; G6PD = glucose-6-phosphate dehydrogenase, Address correspondence to Michelle Petri, M.D., M.P.H., Division of Rheumatology, Johns Hopkins University School of Medicine, 1830 E. Monument St., Suite 7500, Baltimore, MD 21205. Hydroxychloroquine (Plaquenil) has been shown to reduce arthritis pain associated with SLE. This requires compliance with office visits and medications, and lifestyle modifications to reduce or prevent associated problems such as hyperlipidemia, obesity and hypertension. et al. Risk factors for coronary artery disease in patients with systemic lupus erythematosus. Joseph L, Zuily S, Contact Ciurea PL. 7. Vrabie CD. Petri M, Ann Rheum Dis. et al. et al. Thorax. Ocular manifestations of systemic lupus erythematosus. et al. Selton-Suty C, Guidelines for the management of systemic lupus erythematosus in adults. Some patients with very severe cases of discoid lupus erythematosus may not respond adequately to the usual dosage of hydroxychloroquine, which is 400 mg per day for a normal-sized adult. 19. Arthritis Res Ther. Arthritis Rheum. Petri M, Gordon C. In patients with systemic lupus erythematosus, cellular antigens exposed during apoptosis incite an immune response.4. 11. Osteonecrosis, also called avascular necrosis of bone, occurred in 14 percent of patients in one study.8, Osteonecrosis (avascular necrosis of bone), Occurs in 14 percent of patients with systemic lupus erythematosus, Core decompression of bone is an effective treatment in early stages of the disease, Occurs in 64 percent of patients with systemic lupus erythematosus, Osteoporosis of the lumbar spine is associated with the highest dosage of prednisone and the cumulative effects of prednisone, Calcium, vitamin D, calcitonin and bisphosphonates are effective treatments (even in premenopausal women with osteoporosis). de Pascual-Medina AM, Serologic tests such as antinuclear antibodies, anti-Rho, anti-La, anti-RNP, anti-Sm, anti-dsDNA and antiphospholipid antibodies are helpful to confirm the diagnosis. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. et al. Arthritis Rheum. The aim of this guideline was to produce recommendations for the management of adult lupus patients in the UK that cover the diagnosis, assessment and monitoring of lupus and the … et al. Background: why lupus needs specialist care – it is a cause of premature death. Khamashta MA, Curr Cardiol Rev. Arthritis Rheum. The Hopkins Lupus Pregnancy Center: 1987–1991 update. Casciola-Rosen L, 2010;28(1):61–73. Adapted with permission from Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. 1982;25:1271–7. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Low-dose glucocorticoids can be used to treat most manifestations of lupus. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. 2007;57(2):225]. Diagnostic accuracy for lupus and other systemic autoimmune diseases in the community setting. Bernatsky S, Howard D, Aspreva Lupus Management Study Group. et al. Autoimmun Rev. Wilkinson A, Orbai AM, Tektonidou M, Oparil S, Weisman MH, Craig JC, 13. The cause of systemic lupus erythematosus remains elusive. Neurologic manifestations of systemic lupus erythematosus in children and adults. Predisposing factors include genetic factors (certain types of human leukocyte antigens and null complement alleles), environmental factors including sun exposure, some drugs such as sulfa antibiotics, and hormonal factors. Source: For more information on the Choosing Wisely Campaign, see Tench CM, It is important that glucose-6-phosphate dehydrogenase status be checked in black patients before they begin dapsone therapy. Continues to evolve over time and overlap with those of many other.... Specificity and 85 % sensitivity immunosuppressive drugs such azathioprine ( Imuran ) or cyclophosphamide Cytoxan... Ciurea PL brand name in parentheses, when available Venuturupalli SR. New insights into mechanisms of therapeutic of! 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