Systemic lupus erythematosus: an update

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease. Predominantly affecting young women, it continues to have an unacceptably high morbidity burden.(1) Its clinical heterogeneity often makes diagnosis and management challenging even for experienced physicians. Additionally, the natural history of SLE is variable, with some patients experiencing fluctuating periods of relative inactivity contrasted by disease flare while others have persistently active disease.(2) The classification criteria for SLE have recently been reappraised, and the new criteria have facilitated a more robust diagnostic process. The treatment approach of early and sustained control of disease activity is likely to lead to the prevention of irreversible end-organ damage,(3) which correlates with early mortality.(4) Advances have also been made in the therapeutic area, based on the exciting translational research identifying new targets that develop into therapies promising to ameliorate disease activity and lessen the reliance on treatments such as glucocorticoids. Patients with SLE experience poor health-related quality of life (HR-QoL),(5) which can be worse than in groups with other chronic diseases such as congestive cardiac failure, myocardial infarction and diabetes.(6) The determinants of HR-QoL in SLE are complex, but there may be disease-and treatment-related factors as well as factors associated with health care provision that may be amenable to change. Here, we present an overview of the key advances made in the diagnosis and management of this challenging disease, based on a review of recently published literature in peer- reviewed journals and international guidelines.