Systemic Lupus Erythematosus in Primary Care: An Update and Practical Messages for the General Practitioner

Abstract

Systemic Lupus Erythematosus (SLE) is a complex chronic autoimmune disease that manifests a wide range of organ involvement. Traditionally, the diagnosis and management of SLE is provided at secondary and tertiary centers to ensure prompt initiation of treatment, adequate control of flares and prevention of irreversible organ damage. Notwithstanding, the role of primary care in SLE is also emerging as there are still significant unmet needs such as the diagnostic delay at the community level and the high burden of therapy- and disease-related comorbidities. In the present review, we summarize practical messages for primary care physicians and general practitioners (GPs) concerning early diagnosis and proper referral of patients with SLE. In addition, we discuss the main comorbidities complicating the disease course and the recommended preventative measures, and we also provide an update on the role and current educational needs of GPs regarding the disease.

Immunogenicity, safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis

“…As such, there is a dearth of reliable information concerning biomarkers of immunogenicity and future studies should try to address this crucial question. SLE patients are at high risk for developing pneumococcal pneumonia (75). According to a retrospective survey conducted on data from 3 healthcare claims repositories, rates of all-cause pneumonia among subjects aged 18 years and older with chronic medical conditions were approximately 3 times the rates in age-matched healthy controls (76).…”

Case Report: Pregnancy with Systemic Lupus Erythematosus (SLE)

“…Systemic Lupus Erythematosus or better known as SLE is one of the autoimmune rheumatic diseases that require special attention both in recognizing the clinical appearance of the disease and its management. As a doctor in primary care, general practitioners should understand that this disease has a thousand faces 1,2 . The patient does not present with the typical symptoms that he has SLE, but it can be just itching, redness of the face and joint pain, where the doctor may give a wrong diagnosis with allergies or arthritis.…”

“…Some of the following educational tips and practices can be done on these patients: 1) SLE is a hereditary disease. As many as 44% of SLE cases are hereditary cases that can be reduced 1,2,3 . The doctor can continue to observe the possibility of this case appearing in children with SLE or educate the hereditary possibility of this case in survivors of SLE; 2) Provision of vitamin D. Vitamin D is given to prevent bone loss; 3) Vaccination.…”

“…Usually recommended are pneumococcal and influenza vaccines. This vaccine is given when the patient is in a controlled condition, including HPV vaccination for the prevention of cervical cancer in SLE patients 1,2,3 ; 4) Attention to reproductive functions. If pregnant, patients with SLE have a higher risk for preeclampsia-eclampsia.…”

The Burden of Rheumatic Diseases in the Community: Raising Awareness in Primary Care

“…Interestingly, some of the uncommon RMDs, such as Systemic Lupus Erythematosus, are not considered as rare as they used to, in the past [16,17]. Yet, for a PCP, it is not only the cases that a decision to referral with "possible SLE diagnosis" will be made, but all the cases that SLE is suspected, with low probability, and the patient should be reassured or re-evaluated [18]. In addition, it has to be stressed out that the clinical features of SLE may actually differ from "text-book" descriptions, as SLE does not present only in young girls, but also in middle-aged women and, increasingly, in men and, commonly, manifest with milder/atypical presentation at early stages [18].…”