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Management of Systemic Lupus Erythematosus

7. TREATMENT
7.1 Non-Pharmacological Treatment

There is limited evidence on the non-pharmacological treatment of SLE.

a. Sun protection
Sunlight can induce or exacerbate SLE in a wide variety of cutaneous
manifestations including discoid lupus erythematosus and acute CLE.
These conditions may lead to physical and psychological burden to
patients.

Two guidelines recommend the use of broad-spectrum sunscreen for
effective protection against ultraviolet exposure. 21; 50 This is supported
by a systematic review that showed application of sunscreen with sun
protection factor (SPF) 50 - 75 reduced lesion development in the
setting of photo-provocation among patients with CLE. 51, level I

In addition, patient should be advised on sun avoidance and the use of
protective clothing. 21

b. Nurse-led care
Patients with SLE face a unique set of challenges due to the variability of
the symptoms experienced. Nurses play an important role in addressing
these challenges by providing a multitude of nurse-led interventions such
as patient educational sessions, counselling, exercise and transitional
care programs. A randomised controlled trial (RCT) among patients
with SLE showed that transitional care programmes led by specialist
nurses compared with usual care group had significant improvement in
patient self-care and quality of life as well as reduction in readmission
rate up to 90 days. 52, level I

c. Physiotherapy/exercise and psychological therapy
In a systematic review on patients with SLE, combination of
physical activity (aerobic exercise) or psychological interventions
(psychoeducation, mindfulness-based cognitive therapy and
biofeedback-assisted cognitive behaviour therapy with relaxation
techniques) with usual medical care was compared with usual medical
care alone. The combined treatment was more effective in improving
fatigue, psychological function, pain and quality of life. 53, level I However,
quality assessment of primary studies was not reported.
A recent Cochrane systematic review assessed the effectiveness of
exercise as an adjunct to pharmacological treatment. The intervention
was only more effective compared with other non-pharmacological
treatments adjunct to pharmacological treatment in fatigue, functional
capacity and pain. The quality of primary papers used was generally
low to very low. 54, level I

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