Daniel J. Wallace, MD
Cedars-Sinai/UCLA School of Medicine
Los Angeles, CA

Summary Points

• Patient education about lupus and its treatment and strategies to prevent vascular complications and bone demineralization are important components of management.

• Selective use in lupus of established agents has been shown – methotrexate for synovitis; cyclosporin A for membranous nephritis; and mycophenolate mofetil for glomerulonephritis.

• Promising new agents are in phase I, II, and III trials. These are agents that target B cells, C5a, beta-2 glycoprotein, DNA, IL-10, B lymphocyte stimulators (BLyS), and costimulatory molecules.

Introduction

In 1948, corticosteroids were introduced, and the LE cell prep became available. At that time, 50% of lupus patients died within two years, reflecting the poor prognosis of those who had organ-threatening disease. Improvements in survival of patients with systemic lupus erythematosus (SLE) continued until the late 1980s when 90% with non-organ-threatening disease survived at least 20 years compared to 50% of those with organ involvement. Also at this time, it became apparent that long-term, high-dose corticosteroid therapy improved survival, but at a high cost ­– increased infections, hyperlipidemia, accelerated atherosclerosis, hypertension, obesity, personality changes, hyperglycemia, osteoporosis, cataracts, and glaucoma (1). Further, no new drugs have been approved for the indication of lupus since the 1960s. 

In the last few years, attention has become focused on improving the quality of life of lupus patients through proactive, preventive measures, and new drugs are undergoing clinical trials for the disease. This review will summarize new developments in the management of SLE.