Treatment of SLE (Systemic Lupus Erythematosus)
The treatment of SLE is as varied as its
Although there is no cure for
lupus and it is difficult to predict which
treatment will be most effective for each
patient, there have been significant
gains in treating patients, and there
is general consensus on several
A conservative regimen of physical
and emotional rest, protection from
direct sunlight, a healthful diet, prompt
treatment of infections, and avoidance
of aggravating factors are the mainstays
of lupus therapy. In addition, for female
patients, pregnancy must be planned
for times when the disease is under
control, and the patient is on allowable
This basic component of everyone's
good health is essential for the person
with lupus. The fatigue of lupus is not
sleepiness or tiredness from physical
exertion, but rather a frequent,
persistent complaint often described as
a "bone-tired feeling" or a "paralyzing
Normal rest often does not
refresh the patient or eliminate the
tiredness due to lupus, and fatigue may
persist despite normal laboratory test
The patient and family need
instruction on how to use this tiredness
as a guide for scheduling activity and
rest. It must be reinforced that this
need for rest is not laziness.
10 hours a night of restful sleep, naps,
and "timeouts" during the day are basic
Physical activity should be
encouraged as the patient can tolerate it.
However, in some patients, the fatigue is
more related to fibromyalgia than to the
activity of their lupus.
exercise routine may promote well
being, especially in a patient with
Some scientists believe
that the incidence of fibromyalgia is
increased in patients with lupus.
do not know why, but one hypothesis is
that inflammation from lupus may lead
to the rewiring of the pain pathways in
the central nervous system.
A patient's emotional stressors should
be carefully assessed, because they
may play a role in triggering a flare.
The patient should be instructed on
how to avoid these stressful situations.
However, the physical manifestations of
lupus must be treated as they present
themselves while the emotional stresses
Discussions with family
members on this issue are essential for
providing them with information and
obtaining their support. Counseling for
both the patient and the family may
be an option. Chapter 6, Psychosocial
Aspects of Lupus, explores these issues
in further detail.
Protection from Direct
An abnormal reaction to the ultraviolet
(UV) rays of the sun, photosensitivity
results in the development or
exacerbation of a rash that is sometimes
accompanied by systemic symptoms.
Photosensitivity is common in
All people with
lupus should avoid direct, prolonged
exposure to the sun. Sun-sensitive
patients should frequently apply a
sunscreen. The best sunscreen is one
that protects against both UVA and
To get adequate protection,
patients should be advised to select
either a "broad-spectrum protection"
sunscreen with an SPF of at least 15,
or one that contains micronized zinc
oxide or titanium dioxide, both of which
block UVA and UVB light.
patients should also avoid unprotected
exposure between 10 a.m. and 4
p.m., and wear protective clothing,
such as wide-brimmed hats and long
In severe cases, patients may
wish to purchase special UV-blocking
clothing. People with lupus should be
aware that UV rays are reflected off
water and snow, and that glass, such
as car windows, does not provide total
protection from UV rays.
People with lupus should also know
that fluorescent and halogen lights may
emit UV rays and can aggravate lupus.
This may be an issue for patients who
work indoors, in places with these kinds
Sunscreen and protective
clothing can help minimize exposure,
and plastic devices are available that
block UV emissions from fluorescent or
halogen light bulbs.
Diet and Nutrition
A well-balanced diet is essential in
maintaining good health for all people,
including people with lupus.
low-cholesterol diet is recommended,
given the increased risk of heart
disease in SLE.
When fluid retention,
hypertension, kidney disease, or other
problems are present, a restricted
diet plan may be prescribed. Also,
food intolerances and allergies may
The health professional should
make a note of the patient's dietary
history and suggest diet counseling if
appropriate, especially if the patient has
a problem with weight gain, weight loss,
gastrointestinal (GI) distress, or food
intolerances. Nutritional considerations
in treating people with lupus are
discussed further in Chapter 4, Care of
the Lupus Patient.
Treatment of Infection
Prompt recognition and treatment of
infection is essential for those with
However, cardinal signs of
infection may be masked because of
For example, a fever
may be suppressed because anti
inflammatory therapy is being given.
When an infection is being treated,
the health professional should be alert
to medication reactionsreactions, especially to
antibiotics. Sulfonamide antibiotics may
increase the risk of a lupus flare.
Pregnancy and Contraception
Spontaneous abortion and premature
delivery are more common for women
with SLE than for healthy women.
minimize risks to both mother and baby,
a pregnant woman with lupus should
be closely supervised by an obstetrician
familiar with lupus and high-risk
As long as a woman is not
hypercoagulable, oral contraceptives
may be considered for contraception, as
they do not increase flares.
Surgery may exacerbate the symptoms
Hospitalization may be required
for otherwise minor procedures, and
postoperative discharge may be delayed.
If it is elective, the surgery should be
postponed until lupus activity is under
Immunizations with killed vaccines
have not been shown to exacerbate
Influenza and pneumococcal
vaccines are routinely recommended
for SLE patients.
A patient with lupus
should consult her or his doctor before
receiving any immunizations, even
Source: National Institutes of Health, U.S.Dept of Health and Human Services