Aringer M, Costenbader K, Daikh D 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019; 78:(9)1151-1159

Arriens C, Wren JD, Munroe ME, Mohan C. Systemic lupus erythematosus biomarkers: the challenging quest. Rheumatology (Oxford). 2017; 56:i32-i45

Avouac J, Drumez E, Hachulla E COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study. Lancet Rheumatol. 2021; 3:(6)e419-e426

Ayán C, Martín V. Systemic lupus erythematosus and exercise. Lupus. 2007; 16:(1)5-9

Azevedo PC, Murphy G, Isenberg DA. Pathology of systemic lupus erythematosus: the challenges ahead. Methods Mol Biol. 2014; 1134:1-16

Baker D, Amor S, Kang AS, Schmierer K, Giovannoni G. The underpinning biology relating to multiple sclerosis disease modifying treatments during the COVID-19 pandemic. Mult Scler Relat Disord. 2020a; 43

Baker D, Roberts CAK, Pryce G COVID-19 vaccine-readiness for anti-CD20-depleting therapy in autoimmune diseases. Clin Exp Immunol. 2020b; 202:(2)149-161

Basta F, Fasola F, Triantafyllias K, Schwarting A. Systemic lupus erythematosus (SLE) therapy: the old and the new. Rheumatol Ther. 2020; 7:(3)433-446

Bertsias G, Ioannidis JP, Boletis J EULAR recommendations for the management of systemic lupus erythematosus. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis. 2008; 67:(2)195-205

Bertsias GK, Tektonidou M, Amoura Z Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012; 71:(11)1771-1782

Bertsias GK, Pamfil C, Fanouriakis A, Boumpas DT. Diagnostic criteria for systemic lupus erythematosus: has the time come?. Nat Rev Rheumatol. 2013; 9:(11)687-694

Bessant R, Hingorani A, Patel L, MacGregor A, Isenberg DA, Rahman A. Risk of coronary heart disease and stroke in a large British cohort of patients with systemic lupus erythematosus. Rheumatology (Oxford). 2004; 43:(7)924-9

Choi MY, Fritzler MJ. Autoantibodies in SLE: prediction and the p value matrix. Lupus. 2019; 28:(11)1285-1293

Colaneri M, Sacchi P, Zuccaro V Clinical characteristics of coronavirus disease (COVID-19) early findings from a teaching hospital in Pavia, North Italy, 21 to 28 February 2020. Euro Surveill. 2020; 25:(16)

Cowan H. Examining cardiovascular-related concerns in lupus. British Journal of Cardiac Nursing. 2018; 13:(6)296-298

Curtis JR, Johnson SR, Anthony DD American College of Rheumatology guidance for COVID-19 vaccination in patients with rheumatic and musculoskeletal diseases: version 1. Arthritis Rheumatol. 2021; 73:(7)1093-1107

Cucinotta D, Vanelli M. WHO Declares COVID-19 a pandemic. Acta Biomed. 2020; 91:(1)157-160

Fanouriakis A, Kostopoulou M, Alunno A 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019; 78:(6)736-745

Gianfrancesco M, Hyrich KL, Al-Adely S Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2020; 79:(7)859-866

Giovannoni G, Hawkes C, Lechner-Scott J, Levy M, Waubant E, Gold J. The COVID-19 pandemic and the use of MS disease-modifying therapies. Mult Scler Relat Disord. 2020; 39

Goulielmos GN, Zervou MI, Vazgiourakis VM, Ghodke-Puranik Y, Garyfallos A, Niewold TB. The genetics and molecular pathogenesis of systemic lupus erythematosus (SLE) in populations of different ancestry. Gene. 2018; 668:59-72

Hak AE, Karlson EW, Feskanich D, Stampfer MJ, Costenbader KH. Systemic lupus erythematosus and the risk of cardiovascular disease: results from the nurses' health study. Arthritis Rheum. 2009; 61:(10)1396-1402

Horisberger A, Moi L, Ribi C, Comte D. Impact of COVID-19 pandemic on SLE: beyond the risk of infection. Lupus Sci Med. 2020; 7:(1)

Housey M, DeGuire P, Lyon-Callo S Incidence and prevalence of systemic lupus erythematosus among Arab and Chaldean Americans in southeastern Michigan: the Michigan Lupus Epidemiology and Surveillance Program. Am J Public Health. 2015; 105:(5)e74-9

Isenberg DA, Rahman A, Allen E BILAG 2004. Development and initial validation of an updated version of the British Isles Lupus Assessment Group's disease activity index for patients with systemic lupus erythematosus. Rheumatology (Oxford). 2005; 44:(7)902-906

Jakes RW, Bae SC, Louthrenoo W, Mok CC, Navarra SV, Kwon N. Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: prevalence, incidence, clinical features, and mortality. Arthritis Care Res (Hoboken). 2012; 64:(2)159-168

Jorge A. Hydroxychloroquine in the prevention of COVID-19 mortality. Lancet Rheumatol. 2021; 3:(1)e2-e3

Joshi G, Thakur S, Mayank Poduri R. Exploring insights of hydroxychloroquine, a controversial drug in Covid-19: an update. Food Chem Toxicol. 2021; 151

Kashour Z, Riaz M, Garbati MA Efficacy of chloroquine or hydroxychloroquine in COVID-19 patients: a systematic review and meta-analysis. J Antimicrob Chemother. 2021; 76:(1)30-42

Kuhn A, Bonsmann G, Anders HJ, Herzer P, Tenbrock K, Schneider M. The diagnosis and treatment of systemic lupus erythematosus. Dtsch Arztebl Int. 2015; 112:(25)423-32

Kumar R, Sharma A, Srivastava JK, Siddiqui MH, Uddin MS, Aleya L. Hydroxychloroquine in COVID-19: therapeutic promises, current status, and environmental implications. Environ Sci Pollut Res Int. 2021; 28:(30)40431-40444

Lam GK, Petri M. Assessment of systemic lupus erythematosus. Clin Exp Rheumatol. 2005; 23:(5)S120-S132

Landewé RB, Machado PM, Kroon F EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis. 2020; 79:(7)851-858

Larsen JL, Hall EOC, Jacobsen S, Birkelund R. The existential experience of everyday life with systemic lupus erythematosus. J Adv Nurs. 2018; 74:(5)1170-1179

Lee YH, Choi SJ, Ji JD, Song GG. Overall and cause-specific mortality in systemic lupus erythematosus: an updated meta-analysis. Lupus. 2016; 25:(7)727-734

Li QZ, Zhou J, Lian Y, Zhang B Interferon signature gene expression is correlated with autoantibody profiles in patients with incomplete lupus syndromes. Clin Exp Immunol. 2010; 159:(3)281-291

Lu LJ, Wallace DJ, Ishimori ML, Scofield RH, Weisman MH. Review: Male systemic lupus erythematosus: a review of sex disparities in this disease. Lupus. 2010; 19:(2)119-129

Mantovani Cardoso E, Hundal J, Feterman D, Magaldi J. Concomitant new diagnosis of systemic lupus erythematosus and COVID-19 with possible antiphospholipid syndrome. Just a coincidence? A case report and review of intertwining pathophysiology. Clin Rheumatol. 2020; 39:(9)2811-2815

Manzi S, Meilahn EN, Rairie JE Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol. 1997; 145:(5)408-415

Manzi S, Selzer F, Sutton-Tyrrell K Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus. Arthritis Rheum. 1999; 42:(1)51-60<51::AID-ANR7>3.0.CO;2-D

Mason A, Rose E, Edwards CJ. Clinical management of lupus patients during the COVID-19 pandemic. Lupus. 2020; 29:(13)1661-1672

McElhone K, Abbott J, Gray J, Williams A, Teh LS. Patient perspective of systemic lupus erythematosus in relation to health-related quality of life concepts: a qualitative study. Lupus. 2010; 19:(14)1640-1647

Murphy G, Isenberg D. Effect of gender on clinical presentation in systemic lupus erythematosus. Rheumatology (Oxford). 2013; 52:(12)2108-2115

Murphy G, Isenberg DA. New therapies for systemic lupus erythematosus—past imperfect, future tense. Nat Rev Rheumatol. 2019; 15:(7)403-412

Murphy G, Isenberg DA. Biologic therapies for systemic lupus erythematosus: where are we now?. Curr Opin Rheumatol. 2020; 32:(6)597-608

National Institute for Health and Care Excellence. COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders. 2021. (accessed 25 March 2022)

Ng X, dosReis S, Beardsley R, Magder L, Mullins CD, Petri M. Understanding systemic lupus erythematosus patients' desired outcomes and their perceptions of the risks and benefits of using corticosteroids. Lupus. 2018; 27:(3)475-483

NHS England. Clinical commissioning policy: Rituximab for refractory Systemic Lupus Erythematosus (SLE) in adults and post-pubescent children. 2020. (accessed 29 March 2022)

O'Neill SG, Isenberg DA. Immunizing patients with systemic lupus erythematosus: a review of effectiveness and safety. Lupus. 2006; 15:(11)778-783

Oxford handbook of musculoskeletal nursing, 2nd edn. In: Oliver SM (ed). Oxford: Oxford University Press; 2020

Petri M, Orbai AM, Alarcón GS Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012; 64:(8)2677-2686

Raj P, Li Q-Z, Karp D, Olsen N Antinuclear antibodies in general population: what does that mean? (P4535). Journal of Immunology. 2013; 190:(1)

Ramirez GA, Gerosa M, Beretta L COVID-19 in systemic lupus erythematosus: data from a survey on 417 patients. Semin Arthritis Rheum. 2020; 50:(5)1150-1157

Rathi M, Singh P, Bi HP Impact of the COVID-19 pandemic on patients with systemic lupus erythematosus: observations from an Indian inception cohort. Lupus. 2021; 30:(1)158-164

Rees F, Doherty M, Grainge M, Davenport G, Lanyon P, Zhang W. The incidence and prevalence of systemic lupus erythematosus in the UK, 1999-2012. Ann Rheum Dis. 2016; 75:(1)136-41

Rees F, Doherty M, Grainge MJ, Lanyon P, Zhang W. The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies. Rheumatology (Oxford). 2017; 56:(11)1945-1961

Renau AI, Isenberg DA. Male versus female lupus: a comparison of ethnicity, clinical features, serology and outcome over a 30 year period. Lupus. 2012; 21:(10)1041-8

Riveros Frutos A, Casas I, Rúa-Figueroa I Systemic lupus erythematosus in Spanish males: a study of the Spanish Rheumatology Society Lupus Registry (RELESSER) cohort. Lupus. 2017; 26:(7)698-706

Robinson M, Cook SS, Currie LM. Systemic lupus erythematosus: a genetic review for advanced practice nurses. J Am Acad Nurse Pract. 2011; 23:(12)629-637

Romero-Diaz J, Isenberg D, Ramsey-Goldman R. Measures of adult systemic lupus erythematosus: updated version of British Isles Lupus Assessment Group (BILAG 2004), European Consensus Lupus Activity Measurements (ECLAM), Systemic Lupus Activity Measure, Revised (SLAM-R), Systemic Lupus Activity Questionnaire for Population Studies (SLAQ), Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Arthritis Care Res (Hoboken). 2011; 63:S37-46

Ruiz-Irastorza G, Khamashta MA. Hydroxychloroquine: the cornerstone of lupus therapy. Lupus. 2008; 17:(4)271-273

Santos MJ, Carmona-Fernandes D, Canhão H, Canas da Silva J, Fonseca JE, Gil V. Early vascular alterations in SLE and RA patients--a step towards understanding the associated cardiovascular risk. PLoS One. 2012; 7:(9)

Sinha N, Balayla G. Hydroxychloroquine and COVID-19. Postgrad Med J. 2020; 96:(1139)550-555

Spihlman AP, Gadi N, Wu SC, Moulton VR. COVID-19 and systemic lupus erythematosus: focus on immune response and therapeutics. Front Immunol. 2020; 11

Stojan G, Petri M. Epidemiology of systemic lupus erythematosus: an update. Curr Opin Rheumatol. 2018; 30:(2)144-150

Sullivan KE. Genetics of systemic lupus erythematosus. Clinical implications. Rheum Dis Clin North Am. 2000; 26:(2)229-256

Thong B, Olsen NJ. Systemic lupus erythematosus diagnosis and management. Rheumatology (Oxford). 2017; 56:i3-i13

van Vollenhoven RF, Mosca M, Bertsias G Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis. 2014; 73:(6)958-967

Wallace B, Washer L, Marder W, Kahlenberg JM. Patients with lupus with COVID-19: University of Michigan experience. Ann Rheum Dis. 2021; 80

Ward MM, Marx AS, Barry NN. Comparison of the validity and sensitivity to change of 5 activity indices in systemic lupus erythematosus. J Rheumatol. 2000; 27:(3)664-670

Wheeler T. Systemic lupus erythematosis: the basics of nursing care. Br J Nurs. 2010; 19:(4)249-253

Yee CS, Cresswell L, Farewell V Numerical scoring for the BILAG-2004 index. Rheumatology (Oxford). 2010; 49:(9)1665-1669

Systemic lupus erythematosus: overview, management and COVID-19

07 April 2022
Volume 31 · Issue 7


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).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content