Review of systemic lupus erythematosus

Advances in the management of systemic lupus erythematosus (SLE) are discussed in a recent clinical review. Given the complexity of the subject the article focuses on areas of consensus and major new developments, together with suggestions to aid general practitioners.Writing in the British Medical Journal Dr David D'Cruz (St Thomas' Hospital, London) outlines that whilst SLE was once considered a rare disease with a universally fatal outcome, the reality is that of a chronic illness that may be life-threatening when major organs are affected but more commonly results in chronic debilitating ill health. "The past 20 years have shown that this disorder is common and treatable?[and that]?most patients now have almost normal life spans," he remarked. Dr D'Cruz noted; however, that delays in diagnosis, especially in patients with low-grade disease, remains a problem. The key to diagnosis, he states, is a complete systems review and investigations to determine the extent of organ involvement, with this process being a shared responsibility between primary and secondary care. "It is difficult to predict which patients will progress to severe multi-system disease with a poor outcome," he remarks. "In general, morbidity and mortality is higher in patients with extensive multi-system disease and multiple auto-antibodies. Prognosis ultimately depends on the amount of damage (permanent scars or irreversible organ dysfunction) accrued over the course of the disease."The review continues by examining approaches to disease management, targeting inflammation and thrombosis and minimising organ damage. Accelerated atherosclerosis is discussed as a major contributor to premature death through myocardial infarction and cerebrovascular disease.D'Cruz concluded his review by describing the future as "promising" in terms of potential new treatments. "The remaining challenges include improving the quality of life for patients by minimising use of corticosteroids, reducing infections and fatigue, and minimising cardiovascular risks that still claim considerable loss of life," he added. Reference...