Systemic lupus erythematosus

The Diagnosis and Treatment of Systemic Lupus Erythematosus

“…The musculoskeletal system is involved in around 90% of patients with SLE. In addition to myalgia and arthralgia, arthritis of small and large joints may occur (2). Tendovaginitis and synovitis can be detected by sonography and/or magnetic resonance imaging.…”

“…SLE, systemic lupus erythematosus the major causes of mortality in SLE (4). The most common form of pulmonary involvement is dry or wet pleurisy (40 to 60%); lupus pneumonitis and pulmonary fibrosis are rare (2). The central nervous system is affected in about 15 to 50% of patients with SLE, but due to the low specificity (e.g., headache) and high variability of the symptoms, their identification as part of SLE often proves difficult (2,12).…”

“…The most common form of pulmonary involvement is dry or wet pleurisy (40 to 60%); lupus pneumonitis and pulmonary fibrosis are rare (2). The central nervous system is affected in about 15 to 50% of patients with SLE, but due to the low specificity (e.g., headache) and high variability of the symptoms, their identification as part of SLE often proves difficult (2,12). Besides neuropsychiatric manifestations such as cognitive deficits, psychosis, and depression, organic brain syndromes, epileptic seizures, and transverse myelitis may occur, as well as vascular events (e.g., vasculitis, arterial/venous thrombosis in the case of antiphospholipid antibodies) and peripheral neuropathy (12, e13).…”

“…Furthermore, the positive impact of antimalarials on lipid and glucose metabolism have been described, as well as a reduction of thromboembolisms with a favorable influence on cardiovascular risk in SLE, and antineoplastic effects have been discussed (22,23). Based on the experience of experts, the continuation of hydroxychloroquine treatment during pregnancy is recommended, • Follow-up (SLE: every 3 to 6 months depending on disease course; lupus nephritis: initially every 2 to 4 weeks for the first 2 to 4 months)* 2 -Medical history (including new symptoms, comedication, infections), physical examination -Evaluate disease activity with standardized score -Evaluate damage according to standardized score (1 ×/year) -Repeat screening for comorbidities (at least 1 ×/year) -Ocular examination in patients taking hydroxychloroquine or chloroquine: base line, then every 6 months (currently being revised by the German Society of Rheumatology in light of recommendations from the USA) (e30, e31) -Laboratory tests -Erythrocyte sedimentation rate -C-reactive protein (in suspected infection or pleurisy) -Blood count, differential blood count -Creatinine -Liver enzymes -Urinary status (protein/creatinine ratio, 24-hour urine and micro scopic examination of urinary sediment as needed) -Complement C3, C4 -Anti-dsDNA antibodies -Instrument-based diagnostics as needed * 1 Modified after (2,8), * 2 modified after (2,8,10,13,21)…”

CD11b regulation of B cell receptor signaling in health and systemic lupus erythematosus.

“…Over 90% of SLE patients also have musculoskeletal system involvement. Myalgia, arthralgia, and arthritis are the most common symptoms of this type (212). The central nervous system is affected in roughly 30% of SLE cases.…”