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Management of Systemic Lupus Erythematosus

           A  wellness  program  providing  social  support,  lifestyle  and  stress
           management  training  among  patients  with  SLE  led  by  a  lupus
           foundation showed improved self-care knowledge, health behaviours,
           mental health status and quality of life. 55, level II-3

           Recommendation 4
           •  Patients  with  systemic  lupus  erythematosus  should  practise
             sun  avoidance  and,  use  protective  clothing  and  broad-spectrum
             sunscreen with at least sun protection factor (SPF) 50.


           7.2  Pharmacological Treatment
           Pharmacological treatment in SLE aims to suppress the disease activity.
           Drug treatment is individualised according to the clinical presentation of
           the disease  and  the  varying  disease  activity. Corticosteroids  are  the
           cornerstone  treatment  in  SLE,  with  immunosuppressants  being  the
           gold standard treatment for major organ involvement. The initial period
           of  intensive  immunosuppressive  treatment,  also  known  as  induction
           therapy, aims at halting immunological activity especially when there
           is high disease activity or major organ involvement. This is followed
           by a less aggressive maintenance treatment to consolidate remission
           and reduce risk of disease flare. Drugs used in the treatment of SLE
           may  have AEs  which  require  close  monitoring  for  toxicity.  Minimum
           long-term treatment is necessary to maintain remission or low disease
           activity.  Treatment  should  be  based  on  a  shared  decision-making
           process between the patient and the clinician.

           Refer to Appendix 7 for Medication in SLE.
           a.  Corticosteroids
           Corticosteroids have anti-inflammatory properties with rapid onset of
           action that is useful in mild to severe SLE. Although there is no new
           retrievable  evidence  on  its  effectiveness,  it  remains  the  cornerstone
           of SLE treatment despite advances in immunosuppressive drugs and
           therapeutic protocols, and development of new drugs. 56, level III

           Long-term use of corticosteroids may lead to various AEs. In a large
           cohort of SLE patients in Taiwan, the common AEs and their incidence
           rate are shown below. 57, level II-2










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