- Systemic lupus erythematosus (SLE) is considered a disease primarily of young women, but can occur in anyone. The prevalence and severity vary with sex, race, ethnicity, and socioeconomic factors.
- Understanding the etiology of SLE and environmental factors that can initiate or exacerbate the disease may make it possible to avoid those triggers.
- SLE is an autoimmune disease characterized by the presence of autoantibodies, some of which may play a role in the pathogenesis of the disease. An understanding of disease mechanisms can lead to targeted drug therapy.
- SLE is a multisystem disease that can involve almost any organ and may present in many different ways. Therapy is determined by the manifestations in each patient. These may change and fluctuate in severity over time.
- Lifestyle changes can modify risk factors for SLE flares and complications.
- The overall goals of therapy are to prevent disease flares and involvement of other organs, decrease disease activity and prevent damage, maintain remission, reduce use of corticosteroids, and improve quality of life, while minimizing adverse effects and costs. Most patients with SLE should receive hydroxychloroquine alone or in combination with other therapy appropriate for the disease manifestations.
- Pregnancy planning is essential for good outcomes. Pregnancy outcomes are best when the disease is controlled before conception. Drugs used to treat SLE may adversely affect fertility and the fetus.
- Antiphospholipid antibodies are associated with arterial and venous thrombosis and obstetric complications.
- Many drugs can induce a lupus-like syndrome. The manifestations and laboratory findings may be different between the traditional drug-induced lupus and that seen with use of tumor necrosis factor-alpha inhibitors.
- Since SLE can present in many different ways, it is difficult to design standard response criteria. Development of appropriate criteria is essential for getting new drugs approved.
On completion of the chapter, the reader will be able to:
Describe the effects of sex, ethnicity, and race on the epidemiology of systemic lupus erythematosus (SLE).
List genetic and environmental factors that can predispose to, precipitate, or exacerbate SLE.
Explain pathophysiologic mechanisms for SLE.
Identify manifestations of SLE and prepare a plan for monitoring disease activity.
Assess whether a patient meets the 2012 Systemic Lupus International Collaborating Clinics Classification Criteria for SLE for participation in a study.
Develop a plan to counsel a patient with SLE about lifestyle changes and nondrug therapy.
Explain proposed mechanisms of action of drugs used to treat SLE and how those impact the disease.
Design a regimen for treating a patient with lupus nephritis based on patient characteristics and concerns.
Formulate an approach to assessing and treating a patient with neuropsychiatric manifestations of SLE.
Devise a treatment regimen for a patient with cutaneous lupus.
Discuss the considerations in selecting therapy for a woman who wishes to have children in the future.
Recommend drug therapy for a pregnant patient.
Evaluate treatment for a patient with antiphospholipid syndrome in association with SLE.
Compare the differences between idiopathic SLE, traditional drug-induced lupus caused by nonbiologic drugs, and lupus ...