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Management of Systemic Lupus Erythematosus

• HCQ -
 the incidence of retinal toxicity was only 0.95/1000 patient-years
 majority of those with retinal toxicity were on HCQ for >5 years
and most used doses of >6.5 mg/kg
• AZA -
 incidence of leukopenia or anaemia was 5 - 20%
 abnormal LFTs requiring discontinuation of drug in 1 - 6%
• MTX -
 LFT abnormalities ranged at 10 - 50%
• CYC -
 incidence of leukopenia or anaemia was 5 - 10%
 increased incidence of cervical dysplasia in patients taking CYC
compared with corticosteroids alone
• MMF -
 incidence of haematological toxicity was 1.1 - 36.8%
• NSAIDs and salicylates -
 most powerful predictor of gastric mucosal injury (OR=26.8,
95%CI 4.9 to 148.6)
 reduced renal function by 58% and increased serum creatinine
by 163% in patients with active LN
 abnormal liver enzymes over 10-day period of use in 44.4% of
patients treated with aspirin and 20% of patients treated with
NSAIDs
Refer to Appendix 7 for Medication in SLE.

9.5 Frequency and Interval

A summary of current guidelines for laboratory monitoring as well as an
overview of laboratory abnormalities of each drug and recommendations
on frequency of monitoring are provided in the Appendix 7 and
Appendix 8.

A prospective cohort study on patients with inactive disease of SLE
showed that a clinic visit interval of 3.8 months was able to identify
silent manifestations of the disease .99, level II-2

Refer to Appendix 7 for the Medication in SLE.

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