Systemic Lupus Erythematosus

Remembering Professor FENG PAO HSII

Cyclophosphamide in Treatment of Systemic Lupus Erythematosus: 7 Years' Experience

This paper describes our experience with cyclophosphamide in the treatment of systemic lupus erythematosus. Since 1965 42 such patients have been treated either singly with cyclophosphamide or in combination with steroid. Serious complications have been ...
ncbi.nlm.nih.gov

Treat-to-Target in SLE

The principle of treating-to-target has been successfully applied to many diseases outside rheumatology and more recently to rheumatoid arthritis. Identifying appropriate therapeutic targets and pursuing these systematically has led to improved care for patients with these diseases and useful guidan…
m.ard.bmj.com

Treat-to-target in systemic lupus erythematosus: overarching principles and bullet points

Overarching principle 1: The management of systemic lupus erythematosus (SLE) should be based on shared decisions between the informed patient and her/his physician(s).

Overarching principle 2: Treatment of SLE should aim at ensuring long-term survival, preventing organ damage, and optimising health-related quality-of-life, by controlling disease activity and minimising comorbidities and drug toxicity.

Overarching principle 3: The management of SLE requires an understanding of its many aspects and manifestations, which may have to be targeted in a multidisciplinary manner.

Overarching principle 4: Patients with SLE need regular long-term monitoring and review and/or adjustment of therapy.

Recommendations:

The treatment target of SLE should be remission of systemic symptoms and organ manifestations or, where remission cannot be reached, the lowest possible disease activity, measured by a validated lupus activity index and/or by organ-specific markers.

Prevention of flares (especially severe flares) is a realistic target in SLE and should be a therapeutic goal.

It is not recommended that the treatment in clinically asymptomatic patients be escalated based solely on stable or persistent serological activity.

Since damage predicts subsequent damage and death, prevention of damage accrual should be a major therapeutic goal in SLE.

Factors negatively influencing health-related quality of life (HRQOL), such as fatigue, pain and depression should be addressed, in addition to control of disease activity and prevention of damage.

Early recognition and treatment of renal involvement in lupus patients is strongly recommended.

For lupus nephritis, following induction therapy, at least 3 years of immunosuppressive maintenance treatment is recommended to optimise outcomes.

Lupus maintenance treatment should aim for the lowest glucocorticoid dosage needed to control disease, and if possible, glucocorticoids should be withdrawn completely.

Prevention and treatment of antiphospholipid syndrome (APS)-related morbidity should be a therapeutic goal in SLE; therapeutic recommendations do not differ from those in primary APS.

Irrespective of the use of other treatments, serious consideration should be given to the use of antimalarials.

Relevant therapies adjunctive to any immunomodulation should be considered to control comorbidity in SLE patients.


Over the past decades, the concept of ‘remission’ has emerged as a moniker for the disease state one would ideally like to achieve when a ‘cure’—the ultimate goal of medical intervention—cannot realistically be hoped for. Originally used in oncology to describe the absence of detectable tumour, remi…

m.ard.bmj.com


Remission? Yes. Cure? Not Yet.

About 15% in one cohort were symptom-free for at least 3 years
medpagetoday.com

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