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. Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. One of the major complications of systemic lupus erythematosus is premature or accelerated atherosclerosis (Table 7). Lancet. The erythrocyte sedimentation rate (LR+ = 5.3 if greater than 100 mm per hour) and C-reactive protein level are useful to quantify disease activity.14, Diagnosis of SLE begins with a high index of suspicion. 2014;63(25 pt B):2889–2934. Khamashta MA, 2007;46(12):1757–1762. Petri M, The frequency of lupus anticoagulant in systemic lupus erythematosus. NGUYET-CAM VU LAM, MD, is associate program director at St. Luke's Family Medicine Residency, St. Luke's University Hospital, Bethlehem, Pa.... MARIA V. GHETU, MD, is clinical faculty and staff geriatrician at St. Luke's Family Medicine Residency, St. Luke's University Hospital, Bethlehem, Pa. MARZENA L. BIENIEK, MD, is a rheumatologist in Whitehall, Pa., who is affiliated with St. Luke's University Hospital. It is also a major cause of morbidity. Respiratory involvement in systemic lupus erythematosus. 1992;93:513–9. In the UK, NICE has accredited the British Society of Rheumatology (BSR) to develop a guidance document on the management of systemic lupus erythematosus in adults. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis. 8. National Arthritis Data Workgroup. Steinberg AD, et al. Systemic lupus erythematosus. 38. de Pascual-Medina AM, All patients with SLE should receive education, counseling, and support. Some patients with lupus erythematosus who have the anti-Rho and anti-La antibodies do have a higher risk of congenital heart block in the fetus. The authors thank Robert Langan, MD, FAAFP, for assistance with the manuscript. Boumpas DT, 1982;25:1271–7. Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association [published corrections appear in, James PA, Godaert GL, Brey RL. Narain S, Although survival rates have improved, over one half of patients with systemic lupus erythematosus have permanent damage in one or more organ systems. Fries JF, Thrombocytopenia, if stable, and if the platelet count remains above 50,000 × 103 per mm3 (50 × 109 per L), should not be associated with bleeding unless the patient has an additional coagulation defect. Plasma homocysteine as a risk factor for atherothrombotic events in systemic lupus erythematosus. Hahn BH, It is very important that a partnership be established between the primary care physician, the rheumatologist and any other physicians caring for the patient. Petri M, 2003;42(9):1050–1054. Reprints are not available from the author. Whiting-O'Keefe Q, 11(June 1, 1998) Branch DW, A double-blind, placebo-controlled trial. Belimumab for the treatment of systemic lupus erythematosus. Patients with active lupus erythematosus and renal disease, or those who require higher dosages of prednisone (greater than 20 mg per day) have an increased risk of preterm birth.19 In spite of these obstacles, prenatal management that is based on a partnership between a rheumatologist and an obstetrician who has experience with high-risk pregnancies usually results in a successful outcome. : the Hopkins lupus cohort: an update, Roubenoff R, et al and ( )..., 54, 57, and 18 through 21 B ) back induction. Ferreira Neves Neto J, Atallah an afpserv @ aafp.org for copyright questions and/or permission requests and. Searches were done in essential evidence plus, clinical evidence, the Cochrane of. Disorder for clini- cians and those affected contact afpserv @ aafp.org for copyright questions and/or permission.. 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