eMedicine Specialties > Physical Medicine and Rehabilitation > Arthritis & Connective Tissue Disorders

Systemic Lupus Erythematosus: Follow-up

Author: Bertram Greenspun, DO, Director of Spinal Dysfunction Clinic, Director of Amputee Clinic, Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Christiana Care Health System, Jefferson Medical College
Contributor Information and Disclosures

Updated: Apr 23, 2009

Follow-up

Further Inpatient Care

  • Follow-up medical care of patients with systemic lupus erythematosus must be ongoing. One physician should coordinate the patient's care. The physician and the patient must be alert to subtle changes in symptoms that may indicate a flare-up in the disease process.
    • Assessing the disease activity is crucial; treatment decisions are based on the assessment.
    • Measuring disease activity has been attempted many times. Since the late 20th century, several have been validated.19
      • SLAM (Systemic Lupus Activity Measure)
      • ECLAM (European Community Lupus Activity Measure)
      • SLEDAI (Systemic Lupus Erythematosus Disease Activity Index)
      • BILAG (British Isles Lupus Assessment Group) - The BILAG is a more comprehensive, at a glance overview in 8 organs/systems, while the others are global indices.
    • At each clinic visit, a CBC, sedimentation rate, and C-reactive protein are recommended to differentiate a flare from infection.
    • A urea and serum creatinine level should be checked. A renal problem is considered with a rapidly rising urea and/or creatinine level.

Further Outpatient Care

  • Refer to the Rehabilitation Program section for a discussion of outpatient treatment for patients with systemic lupus erythematosus.
  • Liver function tests are needed when a patient is receiving particular disease-modifying, antirheumatic drugs.
  • Urine should be checked for red or white cells, as well as for protein and cellular casts. Findings may indicate silent renal disease.

Complications

  • For a discussion of potential complications that are associated with systemic lupus erythematosus, see the Medical Issues/Complications section.

Patient Education

Miscellaneous

  • The American College of Rheumatology classification system for systemic lupus erythematosus (SLE) suggests that a person may be classified as having lupus if he/she has 4 or more of the following 11 criteria7,19 (See images below and Images 1-2):
    • Malar rash
    • Discoid lupus
    • Photosensitivity
    • Oral or nasal ulcers
    • Arthritis
    • Serositis
    • Renal disorder, with blood or protein in urine
    • Seizures or mental illness
    • Hematologic disorders
    • Immunologic disorders
      • Positive LE test
      • Anti-DNA antibody
      • Anti-Smith antibody
      • False positive test for syphilis
    • A positive antinuclear antibody

    • The classic malar rash, also known as a butterfly...

      The classic malar rash, also known as a butterfly rash, of systemic lupus erythematosus, with distribution over the cheeks and nasal bridge. Note that the fixed erythema, sometimes with mild induration as seen here, characteristically spares the nasolabial folds.

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      The classic malar rash, also known as a butterfly...

      The classic malar rash, also known as a butterfly rash, of systemic lupus erythematosus, with distribution over the cheeks and nasal bridge. Note that the fixed erythema, sometimes with mild induration as seen here, characteristically spares the nasolabial folds.


      Photosensitive systemic lupus erythematosus rashe...

      Photosensitive systemic lupus erythematosus rashes typically occur on the face or extremities, which are sun-exposed regions. Photo courtesy of Dr. Erik Stratman, Marshfield Clinic.

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      Photosensitive systemic lupus erythematosus rashe...

      Photosensitive systemic lupus erythematosus rashes typically occur on the face or extremities, which are sun-exposed regions. Photo courtesy of Dr. Erik Stratman, Marshfield Clinic.

 


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
Multimedia: Systemic Lupus Erythematosus
References
Further Reading
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References

  1. Wallace DJ, Hahn BH, eds. Dubois' Lupus Erythematosus. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.

  2. Mackillop LH, Germain SJ, Nelson-Piercy C. Systemic lupus erythematosus. BMJ. Nov 3 2007;335(7626):933-6. [Medline].

  3. Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med. Feb 28 2008;358(9):929-39. [Medline].

  4. Perkins K, Hoffman RW, Bezruczko N. A Rasch analysis for classification of systemic lupus erythematosus and mixed connective tissue disease. J Appl Meas. 2008;9(2):136-50. [Medline].

  5. Peschken CA, Katz SJ, Silverman E, et al. The 1000 Canadian faces of lupus: determinants of disease outcome in a large multiethnic cohort. J Rheumatol. Apr 15 2009;[Medline].

  6. Goldblatt F, Isenberg DA. New therapies for systemic lupus erythematosus. Clin Exp Immunol. May 2005;140(2):205-12. [Medline]. [Full Text].

  7. Fernando MM, Isenberg DA. How to monitor SLE in routine clinical practice. Ann Rheum Dis. Apr 2005;64(4):524-7. [Medline]. [Full Text].

  8. Bonelli M, Savitskaya A, von Dalwigk K, et al. Quantitative and qualitative deficiencies of regulatory T cells in patients with systemic lupus erythematosus (SLE). Int Immunol. May 9 2008;[Medline].

  9. Al Arfaj AS, Khalil N, Al Saleh S. Lupus nephritis among 624 cases of systemic lupus erythematosus in Riyadh, Saudi Arabia. Rheumatol Int. Apr 21 2009;[Medline].

  10. Clarke-Jenssen AC, Fredriksen PM, Lilleby V, et al. Effects of supervised aerobic exercise in patients with systemic lupus erythematosus: a pilot study. Arthritis Rheum. Apr 15 2005;53(2):308-12. [Medline]. [Full Text].

  11. Hicks JE, Miller F, Plotz P, et al. Isometric exercise increases strength and does not produce sustained creatinine phosphokinase increases in a patient with polymyositis. J Rheumatol. Aug 1993;20(8):1399-401. [Medline].

  12. [Best Evidence] Fortin PR, Abrahamowicz M, Ferland D, et al. Steroid-sparing effects of methotrexate in systemic lupus erythematosus: a double-blind, randomized, placebo-controlled trial. Arthritis Rheum. Dec 15 2008;59(12):1796-804. [Medline].

  13. Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med. Mar 7 2002;346(10):752-63. [Medline].

  14. Cozen L, Wallace DJ. Avascular necrosis in systemic lupus erythematosus: clinical associations and a 47-year perspective. Am J Orthop. May 1998;27(5):352-4. [Medline].

  15. Chambers SA, Isenberg D. Anti-B cell therapy (rituximab) in the treatment of autoimmune diseases. Lupus. 2005;14(3):210-4. [Medline].

  16. Abetimus: abetimus sodium, LJP 394. BioDrugs. 2003;17(3):212-5. [Medline].

  17. Petri M, Barr SG, Zonana-Nach A, et al. Measures of disease activity, damage, and health status: the Hopkins Lupus Cohort experience. J Rheumatol. Feb 1999;26(2):502-3. [Medline].

  18. Petri M. Lupus in Baltimore: evidence-based 'clinical pearls' from the Hopkins Lupus Cohort. Lupus. 2005;14(12):970-3. [Medline].

  19. The American College of Rheumatology response criteria for systemic lupus erythematosus clinical trials: measures of overall disease activity. Arthritis Rheum. Nov 2004;50(11):3418-26. [Medline]. [Full Text].

  20. Sinaki M, ed. Basic Clinical Rehabilitation Medicine. 2nd ed. St Louis, Mo: Mosby; 1993.

  21. Brodsky RA, Petri M, Jones RJ. Hematopoietic stem cell transplantation for systemic lupus erythematosus. Rheum Dis Clin North Am. May 2000;26(2):377-87, viii. [Medline].

  22. D'Cruz DP. Systemic lupus erythematosus. BMJ. Apr 15 2006;332(7546):890-4. [Medline]. [Full Text].

  23. Esdaile JM, Abrahamowicz M, Joseph L, et al. Laboratory tests as predictors of disease exacerbations in systemic lupus erythematosus. Why some tests fail. Arthritis Rheum. Mar 1996;39(3):370-8. [Medline].

  24. Frontera WR, ed. Exercise in Rehabilitation Medicine. 2nd ed. Champaign, Ill: Human Kinetics; 2006:175-6.

  25. Foote RA, Kimbrough SM, Stevens JC. Lupus myositis. Muscle Nerve. Jan 1982;5(1):65-8. [Medline].

  26. Gaffney PM, Moser KL, Graham RR, et al. Recent advances in the genetics of systemic lupus erythematosus. Rheum Dis Clin North Am. Feb 2002;28(1):111-26. [Medline].

  27. Ginzler EM, Moldovan I. Systemic lupus erythematosus trials: successes and issues. Curr Opin Rheumatol. Sep 2004;16(5):499-504. [Medline].

  28. Goodman D, Morrissey S, Graham D, et al. Illness representations of systemic lupus erythematosus. Qual Health Res. May 2005;15(5):606-19. [Medline].

  29. Lehman JF, Brunner GD, Martinis AJ, et al. Ultrasonic effects as demonstrated in live pigs with surgical metallic implants. Arch Phys Med. 1959;40:483.

  30. McElhone K, Abbott J, Teh LS. A review of health related quality of life in systemic lupus erythematosus. Lupus. 2006;15(10):633-43. [Medline].

  31. Omdal R, Brokstad K, Waterloo K, et al. Neuropsychiatric disturbances in SLE are associated with antibodies against NMDA receptors. Eur J Neurol. May 2005;12(5):392-8. [Medline].

  32. Lahita R, ed. Systemic Lupus Erythematosus. 4th ed. San Diego, Calif: Academic Press; 2004.

  33. Traynor AE, Schroeder J, Rosa RM, et al. Treatment of severe systemic lupus erythematosus with high-dose chemotherapy and haemopoietic stem-cell transplantation: a phase I study. Lancet. Aug 26 2000;356(9231):701-7. [Medline].

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Keywords

systemic lupus erythematosus, lupus, SLE lupus symptoms, lupus erythematosus, erythematosus, systemic lupus, lupus disease, rash lupus, malar rash, lupus discoid, lupus skin rash, lupus causes, lupus nephritis, cutaneous lupus, lupus butterfly rash, cutaneous lupus erythematosus, lupus rashes, disseminated lupus erythematosus, antinuclear antibodies, arthralgia, myalgia, Raynaud phenomenon, Raynaud's phenomenon, polymyositis, dermatomyositis, arthritis

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Contributor Information and Disclosures

Author

Bertram Greenspun, DO, Director of Spinal Dysfunction Clinic, Director of Amputee Clinic, Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Christiana Care Health System, Jefferson Medical College
Bertram Greenspun, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Congress of Rehabilitation Medicine, American Medical Association, American Physicians Fellowship for Medicine in Israel, and International Society of Physical and Rehabilitation Medicine
Disclosure: Nothing to disclose.

Medical Editor

Martin K Childers, DO, PhD, Associate Professor, Department of Neurology, Wake Forest University Health Services
Martin K Childers, DO, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Osteopathic Association, Christian Medical & Dental Society, and Federation of American Societies for Experimental Biology
Disclosure: Allergan pharma Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching

 
 
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