Management of Patients with Systemic Lupus Erythematosus at the Stage of Primary Care: Answers to Frequently Asked Questions

Systemic lupus erythematosus (SLE) is an autoimmune disease in which many systems and organs are affected, including skin, musculoskeletal system, renal, lungs, hematologic,  cardiovascular, nervous and reproductive systems. Family physicians should be familiar with the manifestations of lupus to aid in early diagnosis, monitoring patients with mild disease, recognizing warning signs of exacerbation that require referral to a rheumatologist, and helping to monitor disease activity and treatment in patients with moderate to severe disease. The American College of Rheumatology offers 11 classification criteria for SLE diagnosis. If a patient meets at least four criteria, lupus can be diagnosed with 95% specificity and 85% sensitivity. All patients with SLE should receive information about the disease, regular counseling, and medical support. Hydroxychloroquine is the cornerstone of treatment, reducing the frequency of disease flares and other common symptoms. Low doses of glucocorticoids can be used to treat most manifestations of SLE. The use of immunosuppressants and cytotoxic agents depends on depends on the body systems affected. To optimize treatment, to improve chronic care, prevent and screen for the comorbidity presence, strong collaboration between a rheumatologist, a patient, and a family physician is important. In this review, we summarize practical recommendations for family physiacians and provide updated information regarding the early diagnosis and management of a patient with SLE, discuss the main associated diseases that complicate the course of the disease, and recommended preventive measures.