LUPUS ERYTHEMATOSUS
Mulia
September 2011
Introduction
SLE is a chronic inflammatory
autoimmune disease of unknown
etiology, with variable clinical
manifestation, course and prognosis.
It is characterized by periods of
remissions and periods of
exacerbations, which may involve
any organ or system in various
combinations.
erican College
of Rheumatology Ad Hoc Committee on SLE guidelines. Arthritis Rheum 1999;42(9):178
Clinical Features
4/11 criteria
Specificity
Sensitivity
~95%
85%
Severe or Life-threatening
SLE
Severe or Life-threatening
SLE
Assessment of
Disease Activity and Severity
Is important for the establishment of
an appropriate treatment program.
Is needed to closely follow-up the
activity of disease.
LAM-6
MEX-SLEDAI
Score:
Specific
Corticosteroids
Prednisone 5 - 30 mg daily are effective
in treatment of mild-to-moderate SLE,
including cutaneous disease, arthritis,
and serositis.
More severe organ involvement
(nephritis,
pneumonitis, hematologic abnormalities, CNS disease,
Corticosteroids
Life-threatening SLE IV pulse MP
(1 g) for 3 days.
Steroid can act as bridging therapy
for the slower-acting
immunomodulatory agents.
Corticosteroids
The dose can then be tapered when
the immunomodulator begins to take
effect.
Once the disease activity is under
control, tapered to none or minimal
daily (prednisone 5 mg/day) or
alternate-day dosing for maintenance
therapy.
Azathioprine
A purine analog.
Azathioprine (22.5 mg/kg/day) is as
an alternative maintenance therapy
to CY in patients with lupus nephritis
and other organ-threatening
manifestations.
Cyclophosphamide
Had significantly
better renal survival
Corticosteroid + intermittent CY
(iv bolus regimens of 0.51
g/m2 BSA)
Corticosteroid alone
C + CY
Mycophenolate Mofetil
RCT MMF appeared to be as effective as
iv CY in inducing short-term remission of
lupus nephritis with a better safety profile.
The role of MMF in improving longterm
outcomes of lupus nephritis remains
unknown.
The dosing range from 500mg to 1500mg twice daily.
Ginzler E, et al. N Engl J Med 2005;353:2219-2228.
Leflunomide
Dehydroepiandrosterone (DHEA)
Thalidomide
Intravenous immunoglobulin (IVIG)
Plasma exchange or plasmapheresis
Autologous Stem Cell
Transplantation
Lupus Nephritis
Histopathology feature is needed to confirm
the initial treatment corticosteroid alone
versus immunosuppresive/cytotoxic drugs.
Salt restriction if hypertension / edema.
Protein restriction when renal function
impairment of 40%.
Long-term Calcium supplement for those
who on corticosteroid >7.5mg daily.
Lupus Nephritis
Use diuretic as needed.
Avoid NSAIDs.
Monitoring renal function: urinalysis,
creatinine, albumin, C3, anti-dsDNA, 24
hour urinary protein, CrCl 1-2 weekly.
Aggressive treatment of hypertension.
Lupus Cerebral
High morbidity and mortality rate.
The American College of
Rheumatology:
Mild symptoms: headache (including
migraine), reactive psychiatry disorder,
cognitive dysfunction, anxiety disorder.
Monitoring SLE
Lifelong monitoring to detect
flares early and institute prompt,
appropriate therapy.
It is important to reduce modifiable
CVD risk factors including tobacco
use, obesity, sedentary lifestyle,
dyslipidemia, and hypertension.
Complement C3, C4
Titer of anti-dsDNA
Complement C3, C4
Titer of anti-dsDNA
Changes in the
certain laboratory
results.
A decrease in serum C3,
C4
An increase in anti-dsDNA
A rise in ESR
A decrease in
Haemoglobin or Leukocyte
or Platelet counts
A rise in CPK level
The appearance of
microscopic haematuria or
proteinuria
May precede a
clinical disease
flare.
Modification of
treatment
Significantly
reduce the
chance of flare
THE
TEA
M
APP
RO
ACH
Summary
SLE is a complex disorder with variable
presentations, course, and prognosis.
The pillar management of SLE consists of
education/counseling, exercise/rehabilitation
program, and pharmacological treatment.
Lifelong monitoring is required for most
patients.
Summary
It should be managed by a team
approach.
THANK YOU
Serologic Abnormalities in
SLE
Mycophenolate Mofetil
MMF is an inactive prodrug of
mycophenolic acid (MPA), which
inhibits inosine
monophosphate dehydrogenase,
lymphocyte proliferation,
and both T- and B-cell function.
Faktor pencetus/eksaserbasi
Procainami
Obat
Obat ::d
Hidralazin
Hidralazin
Metildopa
CPZ,
CPZ, INH
INH
Keguguran
Keguguran
Kehamilan
Kehamilan
Sinar
Sinar UV
UV
(320-400
(320-400 nm)
nm)
SLE
Infeksi
Infeksi
Tindakan
Tindakan
pembedahan
pembedahan
A urinalysis,
24-hour urine protein,
Creatinine serum, Crcl
Complete blood
count,
Lipid profile,
Calcium, Phosphate,
Sodium and Potasium.
1/12
at the onset
of nephritis
A urinalysis,
24-hour urine protein,
Creatinine serum,
Complete blood
count,
Lipid profile,
Calcium, Phosphate,
Sodium and
Potasium.
1/12
at the onset
of nephritis
More often
If the condition
is unstable