Systemic lupus erythematosus: overview, management and COVID-19
Systemic lupus erythematosus is a complex multi-system disease affecting various systems of the body. The aetiology remains unclear; however, it is thought that immune system dysregulation, environmental factors and viral susceptibility can trigger the disease. Mortality remains high due to cardiovascular disease, infection and lupus nephritis. Clinical assessment should comprise an extensive history, detailed physical examination and relevant laboratory tests. Management begins with an in-depth understanding of disease-specific complications and associated comorbidities. Treatments should be based on a shared decision-making process between the patient and the clinician. Review by a specialist nurse is vital for ongoing support and education. Current treatments can increase the risk of COVID-19 infection and disease severity, so caution is needed in the current climate. New treatments are emerging and offer hope to those with refractory disease.
Systemic lupus erythematosus (SLE) is a complex autoimmune-mediated connective tissue disease that affects multiple organs and body systems (Petri et al, 2012; Gouliemos et al, 2018; Basta et al, 2020). Its aetiology remains unclear however environmental factors, immune system dysregulation and viral susceptibility may be possible triggers (Mantovani Cardoso et al, 2020; Oliver, 2020). SLE is characterised by the production of a range of autoantibodies with associated immune complex formation and deposition. Inflammation ensues, resulting in tissue and eventually organ damage (Lam and Petri, 2005). Its onset can be insidious with diverse clinical presentations such as arthritis, skin lesions, Raynaud's phenomenon, alopecia, fatigue, cognitive impairment and nephritis (Murphy and Isenberg, 2013). The clinical course of the disease is variable and unpredictable between individuals, with episodic flares and remissions (Bertsias et al, 2013).
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