SLE or systemic lupus erythematosus is an autoimmune condition involving inflammatory changes of multiple organ systems. This chronic condition is characterized by the immune system attacking the body’s own cells, deeming them a threat. Consequently, the joints, kidneys, skin, brain and other organs are attacked by the immune system. The management therapy, as designed by the healthcare providers like Internal Medicine specialist in Lahore consists of immunomodulatory drugs, cytotoxic agents, immunoglobulin therapy and plasmapheresis. Read on to know more about the long-term treatment options for SLE:
What are the symptoms of SLE?
In different people, SLE produces different symptoms. Moreover, these signs and symptoms come and go and vary in intensity. Patients of SLE often complain of chest pain, fatigue, hair loss, weight loss, sensitivity to sunlight, fever of unknown origin, mouth sores and swollen lymph nodes.
How is SLE diagnosed?
The diagnosis of SLE is based on investigations detecting autoantibody levels like those of antinuclear antibody (ANA), anti-ds DNA antibody, lupus anticoagulant, rheumatoid factor, cryoglobulins, along with complement levels—C3 and C4.
To check for disease progression, other investigations are often done as well. These include: complete blood count, chest x-ray, urine analysis and serum creatinine, ESR, liver function tests, kidney biopsy, coombs test, imaging of the heart, lungs, joints, brain and muscles.
What are the contemporary treatment options for SLE?
For better patient outcomes of SLE, early diagnosis and treatment are mandated by the international medical associations including ACR and EULAR. New recommendations emphasize on preventive strategies being implemented at any stage of the disease to avoid disease progression. Consequently, comorbidities and worsening of disease can be counteracted timely. Once the patient is stable, tapering of mediation with careful monitoring by the healthcare provider is recommended.
Newer therapies for SLE include:
B-cell depleting drugs:
Rituximab is a chimeric monoclonal antibody with affinity for the B cells through CD20 receptors. Rituximab causes death of the self-harming B-cells through antibody-dependent cell-mediated cytotoxicity (ADCC) mechanism. Once the peripheral B cells die—which occurs in 1 to 4 weeks—there is improvement in the symptoms of SLE. This improvement lasts for about 4 to 9 months. When the circulating B cells return to their original number, there is relapse of disease.
High dose corticosteroids :
Intravenous high-dose corticosteroids are administered to SLE patients in disease flare-ups. The regimen consists of methylprednisolone administration, for 3 to 6 doses, depending on the weight of the patient, and this is followed by oral prednisolone later on. Once the life-threatening flare-up has eased, the corticosteroids are tapered off to 10mg daily dose.
Corticosteroids, particularly in the long run, are laden with side effects. Steroid-sparing approach consists of cytotoxic drugs like cyclophosphamide, methotrexate and azathioprine. Physicians need to monitor the patient carefully when they are taking these agents, as substantial risks are associated with their use. Research reports great clinical improvement in patients following the combination of rituximab and cyclophosphamide.
Another B-cell depleting drug is hydroxychloroquine, which is in use as antimalarial. Clinicians use antimalarial agents to speed the process of steroid tapering, or as an alternative to steroids. Even though they are effective in lowering the peripheral B-cell levels, they take months to be effective, and therefore are not to be used in acute attacks of SLE.
Long-term monitoring of SLE patients :
SLE patients are put on strong immunosuppressants, which carry their own risks. Therefore, close follow-up by healthcare professionals and Best Internal Medicine Specialist in Karachi is needed, along with coordination between rheumatologist, neurologist and nephrologist to assess for complications and to prevent them from occurring in the first place.