title: Systemic Lupus Erythematosus: Primary Care Approach to Diagnosis and Management.
abstract: Systemic lupus erythematosus is an autoimmune disease that affects many systems, including the skin, musculoskeletal, renal, neuropsychiatric, hematologic, cardiovascular, pulmonary, 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 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 has 11 classification criteria for lupus. If a patient meets at least four criteria, lupus can be diagnosed with 95% specificity and 85% sensitivity. All patients with lupus should receive education, counseling, and support. Hydroxychloroquine is the cornerstone of treatment because it reduces disease flares and other constitutional symptoms. Low-dose glucocorticoids can be used to treat most manifestations of lupus. The use of immunosuppressive and cytotoxic agents depends on the body systems affected. Patients with mild disease that does not involve major organ systems can be monitored by their family physician. Patients with increased disease activity, complications, or adverse effects from treatment should be referred to a rheumatologist. To optimize treatment, it is important that a rheumatologist coordinate closely with the patient's family physician to improve chronic care as well as preventive health services.
authors.affiliation: St. Luke's University Hospital, Bethlehem, PA, USA.
authors.forename: Nguyet-Cam Vu
authors.initials: NC
authors.lastname: Lam
authors.affiliation: St. Luke's University Hospital, Bethlehem, PA, USA.
authors.forename: Maria V
authors.initials: MV
authors.lastname: Ghetu
authors.affiliation: St. Luke's University Hospital, Bethlehem, PA, USA.
authors.forename: Marzena L
authors.initials: ML
authors.lastname: Bieniek
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D019468:Disease Management; D005194:Family Practice; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000188:drug therapy*; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012017:Referral and Consultation; D012219:Rheumatology; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D006886:Hydroxychloroquine