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PAINSCAN LITERATURE REVIEW
Issue 1, Volume 1
Systemic Lupus Erythematosus (SLE): Current Issues in Management

Introduction

Welcome from Lisa Criscione-Schreiber, MD and Megan E.B. Clowse, MD, MPH

Systemic Lupus Erythematosus (SLE) is a relatively rare disease that affects around 300,000 individuals in the United States.  It predominantly affects women of child-bearing age, with a predilection to be more severe in those of African or South American descent.

While a rare disease, a high proportion (up to 50% in some series) of individuals with SLE are hospitalized each year, with individuals with SLE using more healthcare than healthy individuals in the same age group.

We hope that efforts to educate providers about SLE will lead to better care for this population.  In this review, we selected 8 papers published over the past few years that we felt were important in answering a question or providing important information to general practitioners who will encounter patients with SLE in practice.

The articles we chose fall into 3 general categories.

Group 1:  Populations with SLE, and Risk Factors for Cardiovascular Mortality and Changes in Patient Survival Over Time
Individuals with SLE are at dramatically increased risk for cardiovascular disease, and this is a leading cause of premature death for patients with SLE.  We hope this article highlights the importance of risk factor modification in a young female population.

Group 2:  SLE Therapy
Belimumab, a biologic agent that inhibits B-lymphocyte stimulator (BLyS), in 2011 became the first drug approved to treat SLE since hydroxychloroquine and glucocorticoids in the 1950s.  Therefore, one article reviews efforts to determine which patients may respond to this therapy.

Two articles highlight lupus nephritis, a condition that affects up to half of individuals with SLE and produces substantial morbidity.  One article from the New England Journal of Medicine is a randomized controlled trial of maintenance therapy for lupus nephritis.  The article by Frederic Houssiau, a leader in the field of lupus nephritis for many years, discusses all of the treatments that have been used for this condition and how treatments have evolved.

Lastly, the article on hydroxychloroquine studied patients in the LUMINA (Lupus in Minorities, Nature versus Nurture) cohort to add to our insight into how this old drug gives improvement in SLE.

Group 3:  Recent Articles of Interest to General Practitioners
One article in this group is an attempt by the authors to study the data behind approaches to treatment of inflammatory arthritis in SLE.  Over 90% of individuals with SLE have arthritis, yet there are very few studies that specifically focus on arthritis or its treatment.

The second article is a controlled trial of weight loss in patients with SLE as a way to improve fatigue.  Fatigue is a prominent and disabling symptom in SLE, and traditional therapies including immunosuppressives have little effect on fatigue.  Our independent research efforts are in finding ways to improve fatigue in patients with lupus, and so we applaud the efforts of these investigators to address a most disabling symptom in this population. 

First Article:
Risk factors for cardiovascular mortality in patients with systemic lupus erythematosus, a prospective cohort study
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