Page 65 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology An update on SLE

notable percentage when diluted at 1:160. The prevalence 6.2. Hydroxychloroquine
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of positive ANA tests remained consistent across all age Hydroxychloroquine is recommended for all patients with
groups up to 60 years, the maximum age considered in the SLE. The typical dose is 5 mg/kg/day, with a maximum of
study. If SLE is not present, the most frequent cause for 400 mg daily. It can be administered once or twice daily.
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a positive ANA test is the existence of another connective Hydroxychloroquine has been sh
tissue disease such as Sjögren’s syndrome (affecting
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68% of patients), scleroderma (40 – 75% prevalence), own to reduce overall mortality and improve survival.
rheumatoid arthritis (25 – 50% prevalence), and juvenile Studies also indicate a reduction in disease flares, with one
rheumatoid arthritis (16% prevalence). In addition, ANA trial showing a flare rate of 73% in patients on placebo
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testing may also be positive in individuals diagnosed with versus 35% in those continuing hydroxychloroquine.
fibromyalgia. 67 Benefits extend to reduced symptoms, such as fatigue and
joint pain, and it lowers the risk of thrombotic events, organ
Anti-dsDNA antibodies (70 – 98% prevalence) damage, and cancer. Hydroxychloroquine is generally
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are detectable in patients with positive ANA and a well tolerated, though rare side effects include retinopathy
homogeneous fluorescence pattern. The outcomes of the and QTc interval prolongation, especially in patients on
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enzyme-linked immunosorbent assay require validation other QT-prolonging drugs. 80
using radioimmunoassay (RIA) or the Crithidia luciliae
immunofluorescence test. Moreover, anti-Sm antibodies 6.3. Escalation of therapy
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are specific indicators for SLE, with a prevalence between Moderate disease involves significant but non-organ-
14% and 40%. In addition to causing venous and arterial threatening manifestations such as fatigue, rashes, or
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thromboses and recurrent fetal loss, antiphospholipid hematologic issues. Hydroxychloroquine and short-
antibodies can also be detected in 50% of lupus cases.
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Evaluation is conducted by identifying antibodies to term prednisone (5 – 15 mg/day) are often prescribed.
Immunosuppressants, such as azathioprine, methotrexate,
cardiolipin or beta-2 glycoprotein 1, or by the presence of or mycophenolate mofetil may be added for patients who
a lupus anticoagulant, indicated by extended clotting times require more aggressive treatment. 81
that remain uncorrected in vitro by mixing investigations.
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Furthermore, C3 and C4 must be evaluated as indicators Organ-threatening SLE, such as lupus nephritis or central
of complement intake or deficiency. The evolution of nervous system involvement, requires aggressive treatment.
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SLE is characterized by exacerbations and remissions. Patients are treated with high doses of glucocorticoids (oral
Nonetheless, the ANA titer does not correlate with disease prednisone 1 – 2 mg/kg/day or intravenous methylprednisolone
activity. Conversely, complement factor levels typically 0.5 – 1 g/day for 3 days). Immunosuppressants, such as
decrease concurrently with an elevation in anti-dsDNA mycophenolate, cyclophosphamide, or rituximab are often
antibodies, often happening months before disease onset. added as glucocorticoid-sparing agents. Depending on the
Consequently, it is essential to routinely monitor the treatment, hospitalization may be required. 81
progression of the disease, particularly regarding renal
involvement. 74 6.4. Anifrolumab

A screening laboratory test is recommended for Anifrolumab is a monoclonal antibody targeting the type I
the diagnosis of SLE. A high ESR indicates active IFN receptor and is approved for patients with moderate
SLE, but CRP levels are often normal or only slightly to severe SLE, excluding those with severe lupus nephritis
elevated. A complete blood count analysis may reveal or neuropsychiatric SLE. It blocks cytokines, such as
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thrombocytopenia, leukopenia, and lymphopenia, along IFN-α, which are elevated in many patients with SLE.
with features of AIHA. Renal function test criteria should Anifrolumab shows particular promise in treating skin and
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include serum creatinine, urine analysis, and sediment joint manifestations.
examination. 76 6.5. Belimumab
6. Management of SLE Belimumab, a monoclonal antibody that inhibits B cell
activation by blocking the BLyS protein, is combined
6.1. Photoprotection
with other therapies. It typically takes 3 – 6 months
Exposure to UV light can exacerbate systemic to take full effect, so it is often combined with faster-
manifestations of SLE. Patients are advised to avoid direct acting medications, such as methotrexate in severe cases.
or reflected sunlight and other sources of UV light, such Belimumab is FDA-approved and is a component of some
as fluorescent and halogen lights. Sunscreens with both regimens for lupus nephritis. A meta-analysis of six trials
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UV-A and UV-B protection and SPF ≥55 are recommended. confirmed its efficacy for SLE. 83

Volume 9 Issue 3 (2025) 57 doi: 10.36922/EJMO025090042