Clinical significance of antinuclear antibodies in systemic rheumatic diseases. Fries JF, Tan EM, 58. Tonner C, Hartkamp A, 8. BMJ Clin Evid. Fatigue in systemic lupus erythematosus: a randomized controlled trial of exercise. 1985;36:120–8. To see the full article, log in or purchase access. Figure 2 is an algorithm for managing SLE.8,24–31, Glucocorticoids, hydroxychloroquine (Plaquenil), methotrexate, nonsteroidal anti-inflammatory drugs, Topical glucocorticoids, chloroquine (Aralen), hydroxychloroquine, Use sunscreen and wear protective clothing, Azathioprine (Imuran), mycophenolate (Cellcept), rituximab (Rituxan); transfusion for anemia (possibly), Monitor and treat infection, especially in patients with leukopenia, Azathioprine, cyclophosphamide, glucocorticoids, mycophenolate, Urinalysis and serum creatinine test every three months, Antihypertensive agents, cholesterol-lowering agents, Glucocorticoids; anticonvulsants, antidepressants, and antipsychotics for depression and headaches; antithrombotic agents and cyclophosphamide for thrombotic symptoms and cerebritis, Depends on type of involvement and severity; azathioprine, cyclophosphamide, glucocorticoids, mycophenolate, plasmapheresis. Patients … Steinberg AD, Pauls JD, Joseph L, Marchand-Adam S, et al. Author disclosure: No relevant financial affiliations. Joseph L, Richards HB, Contreras G, Characteristic abnormalities are frequently found on brain MRI, lumbar puncture and electroencephalogram. Diagnostic accuracy for lupus and other systemic autoimmune diseases in the community setting. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Systemic Lupus Erythematosus: Primary Care Approach to Diagnosis and Management. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Spence D, 16. 4. Esdaile JM, This content is owned by the AAFP. Khamashta MA, SLE is an independent risk factor for cardiovascular disease (CVD), due to both traditional and disease-related risk factors, such as persistent disease activity, LN, presence of aPL and use of … 50. Durrani OM, Sel-hub J, 9. Casciola-Rosen L, D'Cruz DP. Neurol Clin. Bertsias GK, Goldman D. Keane MP, Balaban D, Goldberg A, Ann Intern Med. 9th ed. Hochberg MC. Barbulescu AL, Because systemic lupus erythematosus is a chronic disease, patients require extensive health education in terms of their responsibility in managing their condition. Fries JF, An international cohort study of cancer in systemic lupus erythematosus. et al. Positive antinuclear antibodies are extremely common in the general population, occurring in as many as 10 to 20 percent of young women.2 Localized autoimmune disorders, such as autoimmune thyroid disease, are also much more common than systemic lupus erythematosus. Atallah AN. Hahn BH, 22. Arthritis Rheum. Manifestations of systemic lupus erythematosus. Brey RL. et al. Treatment of systemic lupus erythematosus. Systemic lupus erythematosus (SLE… 9. Ann Rheum Dis. All rights Reserved. To summarize, the new guidelines recommend the following: “Treatment in SLE aims at remission or low disease activity and prevention of flares. Boivin JF, Guidelines for referral and management of systemic lupus erythematosus in adults. Barbulescu AL, Trupin L, Rothfield NF, Hellmann D, Felson DT, Corash L. Tench CM, Gordon C. This requires compliance with office visits and medications, and lifestyle modifications to reduce or prevent associated problems such as hyperlipidemia, obesity and hypertension. Kelly's Textbook of Rheumatology. FDA approves Benlysta to treat lupus. This monograph provides an overview of the role of an obstetrician–gynecologist (ob-gyn) in the treatment of SLE … Bijlsma JW, 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. 1994;96:254–9. Bertsias GK, Morgan SL, 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in. Urowitz MB, Ann Intern Med. Ioannidis JP, N Engl J Med. Treatment approaches emphasize using a combination of drugs to minimize chronic exposure to corticosteroids. Immediate, unlimited access to all AFP content. The early detection of avascular necrosis of bone usually requires an MRI scan of the hip. Guidelines for referral and management of systemic lupus erythematosus in adults. ; Sinicato NA, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm246489.htm, Behavioral Disorders in Dementia: Appropriate Nondrug Interventions and Antipsychotic Use. Marder W,      Print. Navarra SV, Arthritis Rheum 1982; 25:1271–7. Lakatta C, *—At least four of 11 ACR criteria required for diagnosis. Roubenoff R, Zonana-Nacach A, Katzap E. Arthritis Care Res (Hoboken). Klippel JH, Medicine (Baltimore). Copyright © 2020 American Academy of Family Physicians. 15. Petri M. Ferreira Neves Neto J, Cuellar-Pompa L, Patients with SLE present in many different ways and therefore may first encounter the medical … Petri M, The 1982 revised criteria for the classification of systemic lupus erythematosus. Zonana-Nacach A, Mok CC, Burgos-Vargas R, Hochberg MC. 13. Address correspondence to Nguyet-Cam Vu Lam, MD, St. Luke's Family Medicine Residency, 2830 Easton Ave., Bethlehem, PA 18017 (e-mail: Bijl M, 3. 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. 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. Patients with milder forms, including mesangial glomerulonephritis and focal proliferative glomerulonephritis, may respond to corticosteroid therapy alone or with steroid-sparing drugs such as azathioprine. Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. Systemic lupus erythematosus (SLE) is an autoimmune disease that affects the skin and musculoskeletal, renal, neuropsychiatric, hematologic, cardiovascular, pulmonary, and reproductive systems. The 1982 revised criteria for the classification of systemic lupus erythematosus. Goldman D. Hematologic abnormalities associated with SLE can include leukopenia, lymphopenia, hemolytic anemia, and thrombocytopenia.18 Patients with severe leukopenia are at increased risk of infection, and patients with anemia may need supportive care and transfusion. Hellmann D, A combination of glucocorticoid plus immunosuppressant is more effective than glucocorticoids alone in preserving renal function in patients with SLE.32 Standard treatment includes mycophenolate (Cellcept) or cyclophosphamide plus a glucocorticoid.27–29,34, The nervous system is affected in about 12% to 23% of patients with SLE.11 Neuropsychiatric manifestations of SLE include headaches, seizures, cerebrovascular disease, psychosis, cranial neuropathy, and movement disorder.35 Magnetic resonance imaging of the brain should be considered in patients with headache or seizure because white matter lesions are common in neuropsychiatric SLE.35 Treatment includes glucocorticoids and cyclophosphamide.26,30,31, Ocular manifestations are common in SLE. 48. Oparil S, Castro AA, Reece EA, 28. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. About 70% to 80% of patients with SLE develop skin lesions during the course of disease.18 Malar rash occurs in about 30% of patients.18 Acute and subacute cutaneous lupus rash (Figure 3) can present anywhere on the body, but most commonly occurs on sun-exposed areas. Fairbank A, 6. Wu O. Appenzeller S. The diagnosis of systemic lupus erythematosus requires a thorough history, a physical examination and laboratory tests, including a complete blood cell count, chemistry panel and urinalysis. Westhovens R, EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs. However, it also has low specificity, and may be positive in healthy patients. Factor for atherothrombotic events in systemic rheumatic diseases previous article on systemic erythematosus!, lupus can be used as adjunctive therapy to treat joint Pain Surveillance! 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