The Assessment Of Disease Activity

1591 WordsJan 22, 20177 Pages
Assessment of Disease Activity: Monitoring of SLE in clinical practice is based upon differentiating disease activity from organ damage accrual. A variety of disease activity indices have been formulated, including the SLEDAI (Systemic Lupus Erythematosus Disease Activity Index), SLAM (Systemic Lupus Activity Measure), BILAG (British Isles Lupus Assessment Group) (Ben-Menachem, 2011). Assessing Chronic Damage of SLE: In 1996, a damage index for SLE was developed by the SLICC and endorsed by the ACR; hence, it has become known as the SLICC/ACR Damage Index which complements other measures of lupus disease activity as an outcome measure (Gladman et al., 1996). There is international consensus that it is the best instrument to measure organ…show more content…
B. Pharmacologic treatments: 1- Non steroidal anti-inflammatory drugs (NSAIDs): NSAIDs are generally effective for musculoskeletal complaints, fever, headaches, and mild serositis (Schur and Wallace, 2012). NSAIDs may cause acute interstitial nephritis, acute tubular necrosis or membranous nephropathy so should be avoided in lupus nephritis. NSAIDS may be responsible for neuropsychiatric features like headache, dizziness, aseptic meningitis, etc. which need differentiation from neuropsychiatric involvement in SLE (Vasudevan and Ginzler, 2009). 2- Glucocorticoids: Lympholytic (lysis of lymphocytes), inhibit mitosis of lymphocytes, reduce size and lymphoid content of the lymph node and spleen, inhibit the production of inflammatory mediators, including Platelet activator factor, leukotrienes, prostaglandins, histamine and bradykinin (Bertram, 2012). In SLE, glucocorticoids remain the most important and most effective short-term therapy. Multiple studies have shown improvement in survival with glucocorticoid use (Lo and Tsokos, 2012). High doses of 1 to 2 mg/kg/day of prednisone (or equivalent) or as intermittent intravenous "pulses" of methylprednisolone used alone or in combination with immunosuppressive agents are generally reserved for patients with significant organ involvement, particularly renal and CNS disease. Patients usually respond to 5 to 15 mg of prednisone daily until a steroid-sparing agent or
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