Systemic lupus erythematosus (SLE) is a complicated autoimmune disease. Lupus patients have a variable disease course and prognosis. A EULAR (The European League Against Rheumatism) task force on SLE, comprised of 19 specialists and a clinical epidemiologist, has issued new guidelines for the treatment of systemic lupus erythematosus. The panel of experts published 12 key recommendations in the July 2007 issue of the Annals of Rheumatic Diseases. The recommendations were developed using an evidence-based approach together with the consensus of the experts:

• New clinical signs, routine lab tests, and immunologic tests should be used to evaluate patients with SLE. Imaging tests and biopsies may be helpful for some patients.
• Lupus activity and flare-ups can be monitored by assessing clinical signs, lab tests, immunologic tests, and established criteria.
• Lupus patients are at high risk for comorbid conditions and patients should be followed for: infections, atherosclerosis, hypertension, dyslipidemias, diabetes, osteoporosis, avascular necrosis, and malignancies.
• Antimalarial drugs (i.e., Plaquenil) and corticosteroids may be used to treat SLE without major organ involvement. NSAIDs (nonsteroidal anti-inflammatory drugs) may be used in patients at low risk for complications. Immunosuppressants may be used for patients non-responsive to steroids.
• Adjunct therapy includes protection from the sun, lifestyle modifications (i.e., exercise, weight control), and other medications.
• In SLE patients with neuropsychiatric manifestations (i.e., headaches, depression), diagnostic evaluation should be similar to people with neuropsychiatric manifestations in the general population.
• Immunosuppressants may help treat patients with neuropsychiatric manifestations related to inflammation (i.e., optic neuritis, acute confusional state, peripheral neuropathy).
• Prednisolone, azathioprine, hydroxychloroquine, and low-dose aspirin may be used in pregnant women with lupus. The drugs Mycophenolate mofetil, cyclophosphamide, and methotrexate must be avoided.
• In patients with SLE and antiphospholipid antibodies, low-dose aspirin may help prevent thrombosis and pregnancy loss.
• Renal biopsy, urine sediment analysis, and tests for proteinuria and kidney function may separately predict the outcome of lupus nephritis treatment but the tests should be interpreted together.
• Corticosteroids together with immunosuppressants protect against progression to end-stage renal disease in patients with lupus nephritis.
• In patients with SLE and end-stage renal disease, transplantation is the treatment method of choice.

Related Resources:

• Guide to Lupus
• Do I Have Lupus?
• Lupus Screening Quiz
• Fast Facts About Lupus
• Test Your Knowledge: Lupus
• 10 Things You Should Know About Lupus

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