CAN CAUSE ANGINA DUE TO MICROVASCULAR ABNORMALITIES.
Medical Care: Care of patients with systemic lupus erythematosus (SLE) depends on disease severity. Periodic follow-up and laboratory testing, including urinalyses, are imperative to detect signs and symptoms of new organ system involvement and to monitor response or adverse reactions to therapies.
" CBC count with differential, creatinine, and urinalyses aid in detection of new organ system involvement and in monitoring response to therapies. At least quarterly visits are recommended in most cases.
" Fever, skin, musculoskeletal, and serositis represent milder disease manifestations, which may wax and wane with disease activity. These are often controlled with low-potency medications or short steroid courses.
" CNS involvement and renal disease must be recognized as more severe disease manifestations and are often treated with more aggressive immunosuppression.
" Acute emergencies in SLE include severe neurologic involvement, systemic vasculitis, profound thrombocytopenia with a TTP-like syndrome, rapidly progressive glomerulonephritis, or diffuse alveolar hemorrhage. Rare serious manifestations such as TTP, diffuse alveolar hemorrhage, or profound steroid-refractory thrombocytopenia may require plasma exchange or intravenous immunoglobulin (IVIG), respectively.
" Preventative care measures are necessary to minimize the risks of steroid-induced osteoporosis and accelerated atherosclerotic disease.
o The ACR Guidelines for the prevention of glucocorticoid-induced osteoporosis suggest traditional steps and the consideration of prophylactic bisphosphonate therapy.
o Recently, numerous authors have also advocated drafting cardiovascular prevention guidelines that equate SLE as a "CAD risk-equivalent" similar to diabetes mellitus. This is based on a 10-year coronary event rate of 13-15% in patients with active SLE compared with a 10-year event rate of 18.8% in patients with known pre-existing coronary heart disease.
Diet: No diet-based treatment of SLE has been proven effective.
Activity: Patients should be reminded that activity may need to be modified as tolerated. Specifically, stress such as physical illness may precipitate SLE flares. Additionally, persons with SLE should wear sunscreen and protective clothing or avoid sun exposure to limit photosensitive rash or disease flares.
DRUG TREATMENT : Treatment of systemic lupus erythematosus (SLE) is guided by the individual patient's manifestations.
Fever, rash, musculoskeletal, and serositis manifestations generally respond to treatment with hydroxychloroquine and NSAIDS. Low-to-moderate dose steroids are necessary for acute flares.
CNS involvement and renal disease constitute more serious disease and often require high-dose steroids and other immunosuppression agents such as cyclophosphamide, azathioprine, or mycophenolate.
Traditionally, class IV diffuse proliferative lupus nephritis has been treated with aggressive cyclophosphamide induction therapy.
Newer lupus nephritis literature has shown that mycophenolate is a safe maintenance agent and is potentially an induction agent, although long-term comparative studies with cyclophosphamide are necessary.
Given the safety profile, some small series have supported the use of mycophenolate and corticosteroids for membranous nephritis.
New investigations are in progress to look at the role of rituximab and other B-cell targeted therapies in SLE.
1. NSAIDS :
- IBUPROFEN
2. ANTIMALARIALS : The mechanism of action of antimalarials in SLE is unknown, but they do not cause generalized immunosuppression. They are useful to prevent and treat lupus skin rashes, constitutional symptoms, arthralgias, and arthritis. They also help to prevent lupus flares and have been associated with reduced morbidity and mortality in SLE.
- HYDROXYCHLOROQUINE
3. IMMUNOSUPPRESSANTS :
- METHOTREXATE
- CYCLOPHOSPHAMIDE
- AZATHIOPRINE
- MYCOPHENOLATE
5. CORTICOSTEROIDS :
- METHYLPREDNISOLONE
- PREDNISONE