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Management of Systemic Lupus Erythematosus

 cellular casts: presence of red cell, haemoglobin, granular, tubular
or mixed

LFT can be deranged due to autoimmune liver disease or liver toxicity
secondary to the use of immunosuppressants. For frequency of
monitoring, refer to Appendix 8.
• Acute phase reactants
Monitoring of ESR and CRP can be useful to distinguish SLE flare from
infection. Raised ESR with normal CRP occur in SLE flares while both
ESR and CRP are elevated in infection. 21

• Autoantibodies and complements
Anti-dsDNA antibodies and complements can fluctuate with disease
activity. In patients with clinical features of active SLE, rising anti-dsDNA
antibodies and/or falling levels of complements indicate disease flare. 21

Other autoantibodies (e.g. ANA and ENA) have not been demonstrated
to be helpful in monitoring disease activity.

Refer to Appendix 8 for Frequency of Monitoring Patients in SLE.

Recommendation 9
• All patients with systemic lupus erythematosus should be monitored
based on clinical and laboratory parameters.*

*Refer to Subchapter 8.1 and 8.2.

9.3 Co-morbidities
a. Infection
Patients with SLE are prone to infection including tuberculosis due
to their immunocompromised state contributed by both disease- and
treatment-related factors. This leads to higher risk of morbidity and
mortality.

High disease activity, severe leukopenia and presence of renal
involvement (with/without hypogammaglobulinaemia in nephrotic
syndrome) contribute independently to infection in SLE. 50

In a cross-sectional study among patients with SLE, the factors
associated with bacterial, viral and fungal infections were renal
involvement, treatment with CYC and accumulated dose of
corticosteroids. Additional factors for bacterial and viral infection were
high SLEDAI score and thrombocytopenia. 90, level III

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