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Management of Systemic Lupus Erythematosus

Source:
1. Jasmin R, Sockalingam S, Cheah T, et al. Systemic lupus erythematosus in the
multiethnic Malaysian population: disease expression and ethnic differences
revisited. Lupus. 2013;22(9):967-971.
2. Shaharir SS, Hussein H, Rajalingham S, et al. Damage in the Multiethnic Malaysian
Systemic Lupus Erythematosus (SLE) Cohort: Comparison with Other Cohorts
Worldwide. PLoS One. 2016;11(11):e0166270.

4. INVESTIGATIONS

Detailed history taking, physical examination and laboratory evaluation
are important to differentiate patients with SLE from those with lupus
mimickers (e.g. infection, malignancy, medications or vaccine-related
reactions). If SLE is suspected based on clinical findings, laboratory
testing can be done to support the diagnosis.

Standard laboratory tests that are diagnostically useful when SLE is
suspected include the following:
i. full blood count (FBC) with differential count
ii. renal parameters: renal profile (RP), urinalysis with microscopy
for sediments, spot urine protein/creatinine ratio (UPCR) or
24-hour urine protein (24hUP)
iii. liver function tests
iv. acute phase reactants: erythrocyte sedimentation rate (ESR)
and C-reactive protein (CRP)
v. autoantibodies: antinuclear antibodies (ANA), anti-double
stranded deoxyribonucleic acid (anti-dsDNA) antibodies,
extractable nuclear antigens (ENA) and antiphospholipid
antibodies (aPL)
vi. complement 3 (C3) and complement 4 (C4)

• Full blood count
A standard or differential blood count may reveal cytopenia e.g.
thrombocytopenia and/or leukopenia and lymphopenia, as well as
autoimmune haemolytic anaemia (AIHA). Anaemia is a common finding
in patients with active lupus, either due to chronicity of the disease or
iron deficiency. 17, level II-2
• Renal parameters
Renal parameters should include RP and urine full examination and
microscopic examination (UFEME) for sediments to screen for kidney
involvement. The spot urine UPCR or 24hUP may be used to quantify
proteinuria.

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