Systemic lupus erythematosus: an update

Abstract

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease predominantly affecting women of childbearing age. New classification criteria for SLE have greater sensitivity and therefore improve the diagnostic certainty for some patients, especially those who may previously have been labelled as having undifferentiated symptoms. Uncontrolled disease activity leads to irreversible end-organ damage, which in turn increases the risk of premature death; early and sustained control of disease activity can usually be achieved by conventional immunosuppressant therapy. The development of biological therapy lags behind that for other rheumatic diseases, with belimumab being the only targeted therapy approved by the Therapeutic Goods Administration. "Treat-to-target" concepts are changing trial design and clinical practice, with evidence-based definition of response criteria in the form of remission and low disease activity now on the horizon. While new therapies are awaited, research should also focus on optimising the use of current therapy and improving the quality of care of patients with SLE.

An interesting case of systemic lupus erythematosus in a patient with Moebius syndrome

“…SLE is a severe chronic inflammatory disease predominantly seen in young females, affecting particularly skin, mucosa, joints, blood, and kidneys . According to the American College of Rheumatology classification of SLE, the individual should meet 14 criteria to be diagnosed with the disease, namely: presence of malar erythema, discoid rash, light sensibility, oral ulcers, nonerosive arthritis, serositis, renal disturbance, neurological disorders, hematological diseases, immunological alterations, and positivity for antinuclear antibodies . In the present case, the patient was presented with discoid rash, oral ulcers, and blood diseases in addition to immunological changes and positivity for ANF.…”

Autoimmune rheumatic diseases: recent advances and current challenges

“…Uncontrolled disease activity leads to irreversible end organ damage, which in turn increases the risk of premature death. Golder and Hoi 2 note that although early and sustained control of disease activity can usually be achieved by the use of conventional immunosuppressants, belimumab is the only targeted therapy approved by the Therapeutic Goods Administration. Significant work is currently underway in improving classification criteria for SLE, thereby improving diagnostic certainty, especially in the previously undifferentiated group.…”

“…Smoking is a strong risk factor for disease progression in inflammatory arthritis, as highlighted by Jones et al 1 for RA and Brown and Bradbury 4 for ankylosing spondylitis. In their narrative review, Golder and Hoi 2 note the significant risk of cardiovascular death in SLE and the importance of targeting traditional cardiovascular risk factors, which is also important in RA 5 . Other important areas for prevention are bone disease, including through use of anti‐resorptive therapy, 2 infections through vaccination programs and cancer through screening programs 6 .…”

“…In their narrative review, Golder and Hoi 2 note the significant risk of cardiovascular death in SLE and the importance of targeting traditional cardiovascular risk factors, which is also important in RA 5 . Other important areas for prevention are bone disease, including through use of anti‐resorptive therapy, 2 infections through vaccination programs and cancer through screening programs 6 . As discussed by Hart and colleagues, 7 awareness that inflammatory rheumatic diseases are frequently complicated by extra‐articular manifestations such as eye involvement is important in order to optimise patient outcomes.…”

Toll-like receptor-9 is involved in the development of B cell stimulating factor-induced systemic lupus erythematosus

“…It is characterized by the activation, proliferation and hyperfunction of B lymphocytes, as well as humoral and cellular immunity functional disorder (2). The majority of cases of SLE are diagnosed in females of childbearing age (3).…”