Page 18 - e-CPG-SLE-8_5_24

Management of Systemic Lupus Erythematosus

1. INTRODUCTION

Systemic lupus erythematosus (SLE) is a chronic autoimmune
multisystem disorder with diverse and complex clinical manifestations
characterised by inflammation in a variety of organs. The exact aetiology
is unknown but genetic, hormonal and environmental factors have been
implicated. This disease has a relapsing-remitting course with a very
unpredictable prognosis and considerable morbidity.

The survival rates of patients with SLE have increased over the past
few decades. 1, level II-2 These may be due to early disease detection,
advancements in medical treatment and improved management of co-
morbidities.

There was considerable variation in survival rates across the countries
in Asia-Pacific region. The 5-year survival rates ranged from 60%
among the Aborigines in Australia, 80% in Malaysia, 94% in South
Korea and 98% in China (Shanghai), while 10-year survival rates
ranged from 64% in Japan to 94% in Hong Kong. 2, level II-2 The leading
causes of death among patients with SLE were infections and active
disease predominantly in lupus nephritis (LN). 3, level II-2

Patients with SLE commonly experience flares during the disease
course which may have adverse impacts on the short- and long-term
outcomes. The treat-to-target recommendations for SLE emphasises
on targeting remission, preventing organ damage, minimising co-
morbidities and drug toxicity, and improving health-related quality of
4
life.
Management of SLE in the Asian population remains a challenge due
to limited access to health care, delayed diagnosis and poor treatment
adherence. The goal of this first national CPG on Management of
5
SLE is to raise awareness among healthcare providers on early SLE
detection, prompt referral to rheumatology services and initiation of
treatment, mainly for non-renal SLE. The purpose of this CPG is to
reduce the variation in practices and address resource implications
in the management of SLE. This will encourage close cooperation
between various stakeholders to enhance quality of life and outcomes
of the affected patients through evidence-based management.

1