Lupus Erythematosus - Pamphlet

Pamphlet by: Nat'l Inst. of Arthritis and Musculoskeletal & Skin Diseases, Jan 22, 1999

* Neurological disorder (seizures or psychosis)

* Hematologic disorder (anemia, leukopenia or lymphopenia on two or more occasions, thrombocytopenia)

* Immunologic disorder (positive LE cell preparation, abnormal anti-DNA or anti-Sm values, false-positive VDRL syphilis test)

* Abnormal ANA titer

Source: Tan E. The 1982 required criteria for the classification of systemic lupus erythematosus. Arthritis and Rheumatism 1982;25:1271-1277. [C] 1982 American College of Rheumatology. Used with permission of Lippincott-Raven Publishers.

Treatment of SLE

The treatment of SLE is as varied as its course. 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 treatments.

A conservative regimen of physical and emotional rest, protection from direct sunlight, a healthful diet, prompt treatment of infections, and avoidance of known allergens and aggravating factors are the mainstays of lupus therapy. In addition, for female patients, pregnancy must be planned for times when the disease is in remission.

Physical Rest

This basic component of everyone's good health is essential for the lupus patient. 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 fatigue." Normal rest often does not refresh the patient or eliminate the tiredness due to lupus, and fatigue may persist despite normal laboratory test results. The patient and family need instruction on how to use this tiredness as a guide to activity and when the person should stop for rest. It must be reinforced that this need for rest is not laziness. Restful sleep of 8-10 hours per night, naps, and "timeouts" during the day are basic guidelines; strict bed rest is usually not required. Physical activity should be encouraged as the patient can tolerate it. An individualized exercise routine may facilitate recovery from a flare and promote well-being.

Emotional Rest

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 are explored. Discussions with the family on this issue are essential for providing information and in 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 Sunlight

Photosensitivity is an abnormal reaction to the ultraviolet (UV) rays of the sun and results in the development or exacerbation of a rash that is sometimes accompanied by systemic symptoms. About one-third of lupus patients are photosensitive. All lupus patients should avoid direct, prolonged exposure to the sun. Sun-sensitive patients should frequently apply a sunscreen with a Sun Protection Factor (SPF) of at least 15, avoid unprotected exposure between 10 a.m. and 4 p.m., and wear protective clothing, such as wide-brimmed hats and long sleeves. Lupus patients 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.