rheumatology and
musculoskeletal
Optimising management of
systemic lupus erythematosus
There is now a better understanding of autoimmunity in systemic lupus erythematosus, which has
led to improved therapeutic strategies, but revolutionary treatments have yet to be discovered
Ioannis Parodis
MD PhD
Division of Rheumatology,
Department of Medicine,
Karolinska Institutet;
Rheumatology Unit,
Karolinska University
Hospital, Stockholm,
Sweden
Systemic lupus erythematosus (SLE) is a chronic
inflammatory autoimmune disorder that
predominantly affects women of child-bearing
age with a ~9:1 female-to-male ratio. Patients
with SLE suffer an impaired health-related quality
of life (HRQoL), and experience fatigue and pain
as major problems.
The pathogenesis of SLE is multifactorial
and its aetiology is largely unknown. 1 Genes,
hormones and environmental factors have been
implicated among the causes of the disease.
Multiple organs may be involved, including
the skin, joints, kidneys and the central nervous
system, with renal and neuropsychiatric SLE
probably constituting the most severe
manifestations. Considerable variations in
severity can be observed during the course of
the disease, with periods of remission and flares,
the intensity of the latter ranging from mild to
severe, to sometimes organ- or life-threatening.
Mortality during the early course of the disease is
associated with activity grade and infections, but
comorbidities, especially cardiovascular disease,
are considerable causes of de