title: The Diagnosis and Treatment of Systemic Lupus Erythematosus.
abstract: BACKGROUND
  Systemic lupus erythematosus (SLE) is an autoimmune disease with a prevalence of 36.7/100 000 in Germany and a female/male ratio of 4:1. The clinical course is variable, with a broad spectrum of organ manifestations; lupus nephritis develops in about half of all patients.
  
  
  METHODS
  This review is based on a selective search of PubMed and the Cochrane Library, including current guidelines and expert recommendations.
  
  
  RESULTS
  Assessment of clinical symptoms, laboratory findings, and optional biopsy results are the basis for early diagnosis of SLE. All patients should be treated with antimalarials as soon as the diagnosis is confirmed. In particular, hydroxychloroquine is associated with a higher rate of remission, fewer relapses, and reduced damage in the course of the disease, even in lupus nephritis. High-dose glucocorticoids should be given only when acutely indicated; immunosuppressives such as azathioprine, methotrexate, or mycophenolate mofetil may be administered to reduce glucocorticoids, according to the EULAR recommendations. Belimumab was recently approved as add-on therapy in autoantibody-positive SLE patients with high disease activity unresponsive to standard treatment. Short-term induction pulse therapy with low-dose intravenous cyclophosphamide, as well as continued mycophenolate mofetil treatment are advances in lupus nephritis.
  
  
  CONCLUSIONS
  The long-term prognosis for SLE has improved markedly in recent decades because of earlier diagnosis and optimized treatment. Further research and randomized controlled trials are needed for the development of specifically targeted therapies.
authors.affiliation: Interdisciplinary Center for Clinical Studies (IZKS), University Medical Center, Mainz, Department of Dermatology, University Hospital of Münster, Nephrological Center, Department of Medicine IV, University Hospital, LMU München, Private practice in internal medicine and rheumatology, München, Department of Pediatric and Adolescent Medicine, University Hospital, RWTH Aachen, Department of Rheumatology, Düsseldorf University Hospital, Düsseldorf.
authors.forename: Annegret
authors.initials: A
authors.lastname: Kuhn
authors.forename: Gisela
authors.initials: G
authors.lastname: Bonsmann
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Anders
authors.forename: Peter
authors.initials: P
authors.lastname: Herzer
authors.forename: Klaus
authors.initials: K
authors.lastname: Tenbrock
authors.forename: Matthias
authors.initials: M
authors.lastname: Schneider
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage*; D001706:Biopsy; D019411:Clinical Laboratory Techniques; D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D010808:Physical Examination; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D005938:Glucocorticoids; D007166:Immunosuppressive Agents