CLINICAL MANAGEMENT GUIDELINE

Systemic lupus erythematosus

ICD10: Systemic lupus erythematosus, unspecified [M32.9]

Treatment: Systemic approach

Systemic lupus is multi-systemic autoimmune disease, targeting ds-DNA and nuclear proteins and most commonly in females (estrogen-related) and African-Caribbean and South Asian descent.

The definition of Mild SLE is clinically stable lupus with no severe (life-threatening) organ involvement, limited to arthritis, rash, mucocutaneous lesions and mild pleuritis. The SLE disease activity index of mild lupus is <6 (SLEDAI<6).

Lupus dependent on a primarily on careful clinical evaluations of the patient with relevant hematological, biochemical and immunological testing.

For clinically and serologically stable disease activity (remission); 6-12 months outpatient appointment is adequate. For clinically stable disease but with serological activity (active); 1-3 months outpatient appointment is adequate.

Periodic lab investigtions check: blood pressure (1+/A) urinalysis (1+/A) renal function (1+/A) full blood count (3/C) liver function tests (4/D) complement levels (2+/C) anti-dsDNA antibodies (2++/B) ESR/CRP (2+/C).

Periodic Lupus co-morbidities check: Treatment-related:atherosclerotic disease, osteoporosis, avascular necrosis, malignancy, infection, hypertension, dyslipidemia, diabetes, high body mass index.


This goal aims primarily to remit the disease activities from evolving into a moderate or severe lupus with a high priority to minimize pharmacological intervention to only hydroxychloroquine.

Level 1 is based on the preventive measures. Level 2 added a systemic steroid as a pulse therapy for remission induction. *Level 3 added a low dose approach of MTX as an addition or substitution to level2.

Treatments

Level 1 / 3
pharmacological
Hydroxychloroquine
ROUTE
Oral
DOSE
6.500 mg
FREQUENCY
OD
pharmacological
avobenzone
ROUTE
topical
DOSE
1.000 mg
FREQUENCY
BID
educational
Aerobic exercises
FREQUENCY
Q24hr
prevention
Smoking cessation therapy

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  • Duplicating mechanism of action of effect
  • Weight based dosing
  • Contraindication
  • Renal dosing
  • Interactions to drugs or diseases
  • Hepatic dosing

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