The treatment of SLE depends on disease severity. It can have a varied clinical course, ranging from a relatively benign illness to fulminant organ failure and death. Most patients have a relapsing and remitting course that requires frequent titration of medications.
Nonpharmacologic measures include sun protection to address photosensitivity, smoking cessation to reduce cardiovascular risks, and immunizations to decrease infection risk (if immunosuppressive agents are used). The most commonly prescribed medication is hydroxychloroquine. Alternatively, treatment may include NSAIDs, glucocorticoids (preferably low dose and short term), and immunosuppressive drugs. If antiphospholipid antibodies are present, low-dose aspirin appears to reduce the risk of thrombosis. Refractory cases of SLE and severe disease with CNS involvement may require high-dose pulse therapy with glucocorticoids and belimumab or rituximab, which have been shown to modulate B-cell activity.
Gordon C, Amissah-Arthur MB, Gayed M, et al. The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. Rheumatology (Oxford). 2018;57(1):e1–e45.
La Paglia GMC, Leone MC, Lepri G, et al. One year in review 2017: systemic lupus erythematosus. Clin Exp Rheumatol. 2017;35(4):551–561.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.