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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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