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Management of Systemic Lupus Erythematosus

Adverse event Incidence rate (per 1000 person-years)
Peptic ulcer 147.84
Bacterial infection 136.42
Fungal infection 42.26
Hypertension 37.67
Osteoporosis 28.17
Fracture 23.77
Tuberculosis 7.85

A meta-analysis of eight small RCTs looked into rate of AEs related
to medium to high dose of corticosteroids in patients with SLE. The
pooled rates were 25/100 patients/year for infections, 12/100 patients/
year for avascular necrosis of the hip and 9/100 patients/year for
hyperglycaemia/diabetes. 58, level I However, quality assessment for
primary studies was not mentioned.

The risk of any new organ damage significantly increases with higher
corticosteroids dosage. 59, level II-2

• The doses and routes of corticosteroids administration should
be based on the severity of organ involvement. The dose should
be minimised during long-term treatment and discontinued when
possible. 21; 50

Recommendation 5
• Corticosteroids should be used for acute flare in systemic lupus
erythematosus.
 The dose should be minimised accordingly and discontinued
whenever possible.

b. Antimalarial (Hydroxychloroquine)
Hydroxychloroquine (HCQ) is an anti-malarial drug with anti-
inflammatory and immunomodulator effects. Long-term use of HCQ
has been shown to ameliorate active SLE manifestations, improve
immunologic parameters and disease activity scores, prevent
disease flares and sustain remission. HCQ is the mainstay of lupus
treatment and is recommended to be used in SLE unless intolerant or
contraindicated. 18; 21; 50
In a large systematic review of RCTs and observational studies, HCQ
use was shown to reduce the rate of flares, achieve higher remission
rate of membranous LN and protect against irreversible organ damage,

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