Page 49 - e-CPG-SLE-8_5_24

Management of Systemic Lupus Erythematosus

The prevalence of tuberculosis among SLE patients is significantly
higher than the general population. 91, level II-2 Hence, there should be a
high index of suspicion for active tuberculosis in SLE especially among
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those on immunosuppressants and high doses of corticosteroids.
A prospective cohort study of patients with SLE showed CRP and
procalcitonin levels were higher in infection than disease flare
(p<0.001). Both serum biomarkers decreased after the infections
resolved. 92, level II-2

• Early detection and prompt treatment of infection is important among
patients with SLE, particularly in the setting of raised CRP and
procalcitonin levels.

b. Osteoporosis
Risk factors for osteoporosis in patients with SLE include corticosteroids
and reduced levels of vitamin D related to the avoidance of sun
exposure. Osteoporosis is assessed by measuring bone mineral density
(BMD) using dual-energy x-ray absorptiometry (DXA) and fracture risk
assessment tool (FRAX) in patients aged 40 - 90 years.

In a retrospective cohort study among female patients with SLE,
significant factors associated with high-risk of osteoporotic fractures
assessed using the FRAX with BMD were nephritis (OR=11.35, 95% CI
1.09 to 118.57) and cumulative dose of corticosteroids (OR=1.10, 95%
CI 1.05 to 1.15). The same study also described low complement levels
(OR=4.38, 95% CI 1.50 to 12.81), high ESR (OR=1.04, 95% CI 1.02
to 1.07) and cumulative doses of corticosteroids (OR=1.05, 95% CI
1.01 to 1.09) as significant factors associated with risk of osteoporosis
assessed using the World Health Organization (WHO) criteria. 93, level II-2
c. Cardiovascular disease
SLE is an independent risk factor for CV disease (CVD), due to both
traditional and disease-related risk factors.

In a large systematic review, the most frequently and consistently
reported predictors of CV events in SLE patients were:94, level II-2
• male gender (OR=6.2, 95% CI 1.49 to 25)
• family history of cardiac disease (OR=3.6, 95% CI 1.15 to 11.32)
• neurological disorders (OR=5.2, 95% CI 2.0 to 13.9)
• dyslipidaemia (OR=3.9, 95% CI 1.57 to 9.71)
• hypertension (OR=3.5, 95% CI 1.65 to 7.54)
• presence of anti-phospholipid antibodies (OR=5.0, 95% CI 3.28 to
7.78)
However, the quality assessment on primary studies was not reported.

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