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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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