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Management of Systemic Lupus Erythematosus

• It is important to identify and manage modifiable cardiovascular
risk factors in SLE patients to reduce cardiac-related morbidity and
mortality.

d. Malignancy
There is an increased incidence of malignancy among patients with
SLE. Evidence from two systematic reviews and one cohort study
showed association of malignancy with SLE:
• Non-Hodgkin lymphomas (SIR=4.39, 95% CI 3.46 to 5.49) 95, level II-2
• leukaemia (SIR=1.75, 95% CI 1.04 to 2.76) 95, level II-2
• lung cancer (RR=1.75, 95% CI 1.37 to 2.24) 96, level II-2
• stomach cancer (RR=1.34, 95% CI 1.05 to 1.72) 96, level II-2
• bladder cancer (HR=1.92, 95% CI 1.15 to 3.21) 97, level II-2

In light of the increased risk, cancer screening should not be overlooked
in the management of SLE. However, there is no evidence that more
intense cancer screening than that applied in general population had
better outcomes for SLE patients. Therefore, routine cancer screening
should follow local recommendations for general population. 21

• Surveillance for malignancy is essential as part of monitoring in
patients with SLE.

Recommendation 10
• Patients with systemic lupus erythematosus (SLE) should be
screened for the following:
 cardiovascular risk factors
 osteoporosis
• Infections in patients with SLE should be identified early and treated
accordingly.

9.4 Drug Adverse Events

Drugs used in the treatment of SLE may have potential AEs and require
regular monitoring.

In a large systematic review of different study designs, multiple toxicities
had been found to be associated with drugs used for the treatment of
SLE: 98, level I
• corticosteroids -
 higher rate of hyperglycaemia or diabetes among patients
taking high dose corticosteroids compared with comparator drug
(OR=1.82, 95% CI 1.04 to 3.19)

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