eMedicine Specialties > Pediatrics: General Medicine > Rheumatology

Systemic Lupus Erythematosus: Follow-up

Author: Marisa S Klein-Gitelman, MD, MPH, Associate Professor of Pediatrics, Northwestern University Feinberg School of Medicine; Head, Division of Rheumatology, Children's Memorial Hospital
Contributor Information and Disclosures

Updated: Dec 8, 2008

Follow-up

Further Inpatient Care

  • Further inpatient care in patients with systemic lupus erythematosus (SLE) is required for severe hematologic, nephrologic, neurologic, or psychiatric disease or for complications from these (eg, severe anemia, renal failure, stroke, seizure), including the use of intravenous high-dose corticosteroids or chemotherapy as required.
  • Hospitalization may also be required for severe hypertension.
  • Inpatient care is appropriate for the patient with unexplained fever to provide sepsis evaluation and treatment, as well as to evaluate the patient for disease flare and to treat accordingly.

Further Outpatient Care

  • Patients with systemic lupus erythematosus have a chronic, often persistent, disease and require constant monitoring of disease activity and modification of medical regimen according to fluctuations in disease status.

Inpatient & Outpatient Medications

Transfer

  • Consider transfer to a tertiary care facility for all children with systemic lupus erythematosus.

Deterrence/Prevention

  • Disease flares lead to poor outcome because of re-injury to vital organs. A poor outcome can be prevented with meticulous medical surveillance and attention to the chronic nature of the disease. Patient and family education is extremely important in this regard.
  • Some flares are the result of excessive sun exposure. These can be avoided using sun protection.

Complications

  • Systemic lupus erythematosus is a high-risk disease with the possibility of end-organ damage to any vital or nonvital organ. This damage can severely affect organ function and can lead to decreased quality of life.
  • Treatment of systemic lupus erythematosus is also fraught with potential complications from steroid adverse effects, infection from immunosuppression, and cardiovascular disease leading to early myocardial infarction.
  • Pregnancy can also complicate systemic lupus erythematosus. Pregnancy increases the risk of renal disease, thrombophlebitis, and disease flare. The infant is at risk for being small for gestational age (SGA) and for neonatal lupus.

Prognosis

  • Current mortality figures suggest that patients have a 95% rate of survival at 5 years. Some clinicians report a 98-100% survival rate at 5 years. These figures depend on disease severity and compliance with therapy.
  • Mortality rates rise over time, with the major causes of death being infection, nephritis, CNS disease, pulmonary hemorrhage, and myocardial infarction. One indicator of morbidity and mortality risk is frequency of emergency department visits.

Patient Education

  • The patient and family must have a thorough understanding of the disease, potential severity, and complications of the disease and therapy.
  • Treatment is difficult, especially for adolescent patients. The physician and parents should expect issues, including depression and noncompliance, to arise. The best method for deterrence is to thoroughly educate the patient and family through discussion, support groups, and literature.
  • For excellent patient education resources, visit eMedicine's Blood and Lymphatic System Center and Muscle Disorders Center. Also, see eMedicine's patient education articles, Lupus (Systemic Lupus Erythematosus), Chronic Fatigue Syndrome, and Chronic Pain.

Miscellaneous

Medicolegal Pitfalls

  • Review disease and medication risks carefully with the patient and family prior to treatment with any new medication.
  • Review the risks of discontinuing therapy and noncompliance with the patient and family.
  • Review diagnosis and prognosis of any new organ manifestations with patient and family.

Special Concerns

  • Educate all patients with systemic lupus erythematosus (SLE) with regard to the serious complications possible from unplanned pregnancy, poor compliance, recreational drug use, and infection, including sexually transmitted diseases (STDs). Poor compliance, in particular, is a significant prognostic factor.
 


More on Systemic Lupus Erythematosus

Overview: Systemic Lupus Erythematosus
Differential Diagnoses & Workup: Systemic Lupus Erythematosus
Treatment & Medication: Systemic Lupus Erythematosus
Follow-up: Systemic Lupus Erythematosus
References
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Further Reading

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Keywords

systemic lupus erythematosus, lupus, SLE, lupus erythematosus, LE, fevers of unknown origin, arthralgia, anemia, nephritis, psychosis, fatigue, rheumatic disease, atherosclerosis, hemolytic anemia, thrombocytopenia, leukopenia, lymphopenia, nephritis, nephrotic syndrome, serositis, arthritis, memory loss, psychosis, transverse myelitis, hemoptysis, edema of the lower extremities, headache, painful mouth sores, pleuritis, pericarditis, livedo reticularis, alopecia, Raynaud phenomenon, tendonitis, myositis, lymphadenopathy, hepatosplenomegaly, stroke, pseudotumor cerebri, cerebral venous thrombosis, aseptic meningitis, chorea, global cognitive deficits, mood disorders, transverse myelitis, hyperthyroidism

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Contributor Information and Disclosures

Author

Marisa S Klein-Gitelman, MD, MPH, Associate Professor of Pediatrics, Northwestern University Feinberg School of Medicine; Head, Division of Rheumatology, Children's Memorial Hospital
Marisa S Klein-Gitelman, MD, MPH is a member of the following medical societies: American College of Rheumatology
Disclosure: Nothing to disclose.

Medical Editor

Barry L Myones, MD, Associate Professor, Departments of Pediatrics and Immunology, Pediatric Rheumatology Section, Baylor College of Medicine; Director of Research, Pediatric Rheumatology Center, Texas Children's Hospital
Barry L Myones, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American College of Rheumatology, American Heart Association, American Society for Microbiology, Clinical Immunology Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Thomas JA Lehman, MD, FAAP, FACR, Clinical Professor of Pediatrics, Department of Pediatrics, Division of Pediatric Rheumatology, Weill-Cornell University; Chief, Hospital for Special Surgery
Thomas JA Lehman, MD, FAAP, FACR is a member of the following medical societies: PM American Allergy Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; Merck, Amgen, Biogen, Zimmer, Wyeth, Johnson&Johnson, Stryker, Medtronic, Zimmer.Abbott,  Ownership interest Other; West Penn Allegheny Health System Consulting fee Consulting; Alpharma Honoraria Consulting; Proctor&Gamble Grant/research funds Independent contractor

 
 
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