McCarthy J, Skaggs BJ. 2002;41(10):1095–1100. Diot E. Because of the high false-positive rates at 1:40 dilution, ANA titers should be obtained only in patients who meet specific clinical criteria (discussed in the clinical recommendations section of this article). Petri M, Khamashta MA, Epub 2012 Jan 30. This review updates a previous article on this topic by Gill, et al. Philadelphia: Saunders, 2001:1105–19.... 2. Manifestations of systemic lupus erythematosus. Conte CG, Satoh M, Lopez-Longo FJ, Immediate, unlimited access to all AFP content. Kavanaugh A, J Rheumatol. Clin Exp Rheumatol. 20. 2000; 124:71–81. Lavilla P, Pirani CL, Grennan DM, Manzi S, Andrade LE, 16. Boivin JF, Ciurea PL. Bertsias GK, Undiagnosed systemic lupus erythematosus in the community. 2014;311(17):1809]. Rivest C, Muangchan C, Guidelines for referral and management of systemic lupus erythematosus in adults. Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. New York, NY: McGraw-Hill; 2012. Cohen AS, Urowitz MB, Published guidelines on SLE cover a complex area of clinical care, but the methodological quality, scope, and recommendations varied substantially. 2013;(2):CD002265. Kwoh CK. Ried K. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus [Letter]. Hyland V, For patients with chronic kidney disease who are receiving long-term immunosuppressive therapy, immunization with 13-valent pneumococcal conjugate vaccine (Prevnar) followed by 23-valent pneumococcal polysaccharide vaccine (Pneumovax) should be considered.54 Live vaccines should not be given to patients with SLE when they are receiving immunosuppressive therapy, and they should be delayed for at least one month after completion of the therapy. https://www.aafp.org/afpsort. Aspreva Lupus Management Study Group. Deyo RA, SLE affects about 300,000 persons in the United States.1 It is twice as prevalent in black persons as in white persons, and it is 10 times more common in females than in males.2 Over the past decade, the five-year survival rate of patients with SLE has improved to more than 95% because of more effective recognition and treatment of infectious and renal complications.3,4 Because patients with SLE are living longer, the focus of care should be comprehensive, including preventive services in addition to treatment.5, A qualitative study in the United Kingdom noted a lack of detailed knowledge about SLE by family physicians and the need for more cohesive health care.6 There is a need for well-coordinated, multidisciplinary health care teams including subspecialists and family physicians to improve chronic care and preventive health services for these patients.7, A committee of the American College of Rheumatology (ACR) recommended that the role of primary care physicians is understanding the manifestations of SLE to aid in early diagnosis, treating and monitoring patients with mild disease, recognizing warning signs to refer to a rheumatologist appropriately, and helping to monitor disease activity and treatment in patients with moderate to severe disease.8, SLE is difficult to diagnose in primary care because many of the symptoms (e.g., fatigue, rash, joint pain) are nonspecific and overlap with those of more common conditions. 2010;27(8):e66–e78. Guidelines for referral and management of systemic lupus erythematosus in adults. | Gomez-Reino JJ, Jakes RW, Whilst primarily aimed at rheumatologists and clinical nurse specialists in lupus, nephrologists, immunologists, dermatologists, emergency medicine practitioners, GPs and many trainees will also use the guideline. Gill JM, Tonner C, 2016;68(1):141–148. 10. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Effects of dehydroepiandrosterone on fatigue and well-being in women with quiescent systemic lupus erythematosus: a randomised controlled trial. Goldenberg J, Related Close-Up: Joint Pain and Fatigue: It Could Be Anything. Treatment of lupus nephritis: a meta-analysis of clinical trials. Association between clinical factors, socioeconomic status, and organ damage in recent onset systemic lupus erythematosus. Other studies21,32,43 have reported sensitivities ranging from 78 to 96 percent and specificities ranging from 89 to 100 percent. Arthritis Rheum. Sato EI. Retrieved March 20, 2003, from http://www.uptodate.com/physicians/rheumatology_toclist.asp. Jansen-McWilliams L, New insights into mechanisms of therapeutic effects of antimalarial agents in SLE. Lupus. Khetarpal R, Del Pino-Sedeño T, 32. 2011;37(2):70–74. 1998;41:778–99. Selton-Suty C, Before the diagnosis can be established, four of 11 clinical and laboratory criteria must be met. Zonana-Nacach A, Berra K, Part I. Arthritis Rheum. 51. et al. Bromocriptine in systemic lupus erythematosus: a double-blind, randomized, placebo-controlled study. Indian Pediatr. Brito-Zeron P, Denniston AK, Arthritis Care Res (Hoboken). Want to use this article elsewhere? Systemic Lupus Erythematosus: Primary Care Approach to Diagnosis and Management. Todd NW, Thumboo J, In persistently active or flaring extrarenal disease, add-on belimumab should be considered; rituximab (RTX) may be considered in organ-threatening, refractory disease. Godaert GL, Gil A, Hallet DC. 1999;26:2363–8. Kelly's Textbook of Rheumatology. 25. 3. A combination of glucocorticoid and mycophenolate (Cellcept) or cyclophosphamide is effective in achieving remission in patients with SLE nephritis. It promotes the referral of patients with the most serious and difficult-to-control disease to specialised lupus centres with experience of new therapies and with multi-disciplinary team backup. et al. Medsger TA Jr, Hydroxychloroquine (Plaquenil) has been shown to reduce arthritis pain associated with SLE. et al. Ferraz MB, Evaluation of the 1982 ARA lupus criteria data set in pediatric patients. 1999; 26:1275–9. Bastos WA, Clinical manifestations of systemic lupus erythematosus. 2011;10(9):514–518. The scope of the guidelines varied considerably (Supplementary Tables 4 and 5, available in the online version of this article at http://onlinelibrary.wiley.com/doi/10.1002/acr.22591/abstract). Collaborative and multidisciplinary efforts to develop comprehensive, high-quality evidence-based guidelines are needed to promote best treatment and health outcomes for patients with SLE. Organ damage in systemic lupus erythematosus progresses over time.29 A cohort study30 found that within seven years of diagnosis, 61 percent of patients developed clinically detectable organ damage, with neuropsychiatric (20.5 percent), musculoskeletal (18.5 percent), and renal (15.5 percent) organ systems most commonly affected. We conducted a systematic evidence-based review of the published literature on systemic lupus erythematosus. 23. The aim of the present work was to identify current available clinical practice guidelines (CPGs) for SLE, … Mok CC, Application of the 1982 revised criteria for the classification of systemic lupus erythematosus on a cohort of 346 Norwegian patients with connective tissue disease. Casatta L, Burgos-Vargas R, Circulation. American College of Pathologists. Gordon C. Gladman DD, EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs. McGrath H, 49. Urowitz MB, Lupus. Welsing PM, Parfitt A, 2014;311(5):507–520. Rodriguez-Mahou M, 1996;5:269–74. When meta-analyses or systematic reviews were identified, they were used instead of the original research articles. Derksen RH. A multicenter study. Cojocaru M, ten Cate R, Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. 1994;12:83–7. 5. Get Permissions, Access the latest issue of American Family Physician. Li Q, Li X, Wang J, Liu H, Kwong JS, Chen H, Li L, Chung SC, Shah A, Chen Y, An Z, Sun X, Hemingway H, Tian H, Li S. BMJ Open. Cyclophosphamide versus methylprednisolone for treating neuropsychiatric involvement in systemic lupus erythematosus. Gordon C, Immunological and clinical differences between juvenile and adult onset of systemic lupus erythematosus. Esdaile JM, Cojocaru IM, McGrath H, 1997;34:979–86. Manzi S, Nived O, Moser KL, Its course is typically recurrent, with periods of relative remission followed by flares. Zuily S, Homburger HA. Cuellar-Pompa L,
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