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Management of Systemic Lupus Erythematosus

           KEY RECOMMENDATIONS

           The  following recommendations  are highlighted  by  the  CPG
           Development  Group (DG) as the key recommendations  that answer
           the main questions addressed in the CPG and should be prioritised for
           implementation.
           DIAGNOSIS AND CLASSIFICATION CRITERIA

           •  Diagnosis  of systemic lupus erythematosus should  be based on
             clinical  manifestations  supported  by  laboratory  findings  following
             exclusion of alternative diagnoses.


           PRINCIPLES OF TREATMENT

           •  All patients with systemic lupus erythematosus (SLE) should have
             clinical assessment of disease activity; this may be done using the
             validated assessment tools for SLE.


           TREATMENT

           •  Patients with systemic lupus erythematosus (SLE) should practise
             sun avoidance,  use protective clothing  and broad-spectrum
             sunscreen with at least sun protection factor (SPF) 50.
           •  Corticosteroids should be used for acute flare in SLE; the dose should
             be minimised accordingly and discontinued whenever possible.
           •  All patients with SLE should be on hydroxychloroquine (HCQ) unless
             intolerant or contraindicated.
           •  Immunosuppressants  should  be considered  as add-on  therapy to
             patients with SLE not responding to HCQ alone or in combination with
             corticosteroids, or when corticosteroids doses cannot be tapered.
           •  Cyclophosphamide  or mycophenolate  mofetil may be used as
             induction therapy in certain major organ involvement in SLE.
           •  Biologics may be used as an adjunct therapy in active SLE despite
             standard therapy with corticosteroids and immunosuppressants.


           MONITORING

           •  All patients with systemic lupus erythematosus  (SLE) should  be
             monitored based on clinical and laboratory parameters.
           •  Patients with SLE should be screened for cardiovascular risk factors
             and osteoporosis.
           •  Infection in patients with SLE should be identified early and treated
             accordingly.

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