Materiały źródłowe

• #1 Lupus: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4875-lupus

  You cant prevent lupus because experts arent sure what causes it. […] You might be able to prevent and reduce lupus flare-ups by avoiding activities that trigger your symptoms, including: […] Avoiding sun exposure: Spending too much time in the sun can trigger lupus symptoms in some people. […] Staying active: Joint pain can make it hard or painful to move. […] Getting enough sleep and protecting your mental health: Living with lupus can be frustrating.

• #2 Lupus: Treatment, living with lupus, and prevention

  https://www.medicalnewstoday.com/articles/323665

  Lupus is a complex autoimmune condition with a wide variety of symptoms. As a systemic disease, it can affect any part of the body. […] There is no way to prevent lupus, but knowing what causes a flare can mean that a person with the condition can be better prepared when they occur. […] Treatment is available for lupus, but understanding how to prevent flares of this disease is very important to improve a persons overall quality of life. […] Here are some things that may reduce the risk of both the onset of lupus, in those who are at risk, and a flare-up. […] For people who have a sensitivity to ultraviolet (UV) light, staying out of the sun can help reduce the risk of a flare-up. […] An individual should always check with their doctor if any new medications are likely to cause a problem.

• #3 Is Lupus Preventable? – Connected Rheumatology

  https://connectedrheumatology.com/preventing-lupus/

  Now, we cant completely prevent lupus yet, but researchers are working hard to better understand the early signs of the disease and who is most at risk. […] One of the most promising avenues for lupus prevention is identifying individuals at high risk of developing the disease. […] By recognizing these risk factors early on, healthcare providers can offer targeted screening and intervention strategies to at-risk individuals, potentially halting the progression of lupus before it fully develops. […] While we continue to make strides in lupus prevention research, there are steps you can take today to minimize your risk of developing lupus or other autoimmune conditions.

• #4 The Expert Series: Managing and preventing flares | Lupus Foundation of America

  https://www.lupus.org/resources/the-expert-series-managing-and-preventing-flares

  Thank you, Alicia. Before we can talk about how to prevent and deal with lupus flares, it is important to know what a lupus flare is. The goal in treating lupus is to have it in remission, or at least slow disease activity. If there is an increase in disease activity, we call it a flare. […] To help you prevent and manage flares, you should one: avoid lupus triggers, two: take medications as prescribed, three: educate yourself about lupus and four have a flare plan in place with your doctor. […] Lupus is a unique disorder because there are things that can trigger it to become more active and cause flares. Many of these can be actively avoided by the person who has lupus although a person who has lupus is powerless in having the disease in the first place. The person who has lupus is in a unique position in that he or she does have the power to decrease the chances of becoming worse.

• #5 Lupus Flares: Recognizing one, triggers, and prevention – Kaleidoscope Fighting Lupus

  https://kaleidoscopefightinglupus.org/lupus-flares-recognizing-one-triggers-prevention/

  Lupus is an autoimmune disease. This means that the immune system, when activated, creates auto-antibodies that attack not only an invading virus, but will turn and continue to attack healthy cells and organs, thus causing inflammation. Therefore, anything that stimulates activity in the immune system can cause a lupus flare. […] There are several ways in which the occurrence and/or the severity of lupus flares can be significantly decreased. From the pharmaceutical side, there are a growing number of drugs that are prescribed for the different manifestations and symptoms of lupus. These, in turn, can have an effect on the experience of the lupus flare itself. […] The most important thing is for you to completely understand this plan and the steps needed to keep your disease under control and avoid a lupus flare.

• #6 Lupus disease: Causes, symptoms, treatment and prevention tips | Health – Hindustan Times

  https://www.hindustantimes.com/lifestyle/health/lupus-disease-causes-symptoms-treatment-and-prevention-tips-101703255434194.html

  Dr Kaushik Bhojani recommended the following preventive measures: […] a) The patient must avoid going out in the sun between 9.00AM to 5.30PM […] b) If unavoidable, then covering up well using long sleeved dresses, using caps and sunglasses are essential. In addition, use of sunscreens with a high SPF of greater than 40 is essential […] c) Avoid going for picnics to beaches or riverside because the sun rays reflected from the water are even more dangerous triggers. Going swimming in the sunlight is simply out of the question […] d) Avoidance of hormonal pills containing Estrogens is necessary, Hence even for contraception, only Progesterone pills are safer […] e) When consulting other doctors, they must be informed hand that you have Lupus and you must contact your rheumatologist to ensure that there is no risk with the treatment prescribed by them […] f) Before undergoing any planned surgery, you must consult your rheumatologist and preferably have your surgeon talk to your Rheumatologist […] g) Importantly, pregnancy planning must be avoided in active disease.

• #7 Patient education: Systemic lupus erythematosus (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/systemic-lupus-erythematosus-beyond-the-basics

  Lifestyle changes and preventive interventions — There are a number of things you can do to help manage your disease. […] Sun protection — Since exposure to ultraviolet (UV) light can cause or worsen lupus symptoms, it’s important to protect yourself from the sun. This includes wearing sunscreen and avoiding direct sun exposure when possible. […] Diet and nutrition — Most people with lupus do not require a special diet but should instead eat a well-balanced diet. A well-balanced diet is one that is low in fat; high in fruits, vegetables, and whole grains; and contains a moderate amount of meat, poultry, and fish. […] Exercise — It can be challenging to exercise when your lupus causes fatigue and other symptoms (such as breathing problems). But being inactive can cause you to lose muscle strength, which can make you feel worse in the long term.

• #8 Is Lupus Contagious? Causes, Risk Factors, and Prevention

  https://www.healthline.com/health/is-lupus-contagious

  You cant necessarily prevent lupus, but you can avoid the factors that trigger your symptoms. For example, you can: […] Limit your time in direct sunlight if sun exposure causes a rash. You should always wear a sunscreen with an SPF of 70 or higher that blocks both UVA and UVB rays. […] Try to avoid medications, if feasible, that make you even more sensitive to the sun. This includes the antibiotics minocycline (Minocin) and trimethoprim-sulfamethoxazole (Bactrim), and diuretics such as furosemide (Lasix) or hydrochlorothiazide. […] Develop stress management techniques. Meditate, practice yoga, or get massages whatever helps calm your mind. […] Stay away from people who are sick with colds and other infections. […] Get enough sleep. Go to bed early enough each night to guarantee yourself seven to nine hours of rest.

• #9 Lupus | Department of Health | Commonwealth of Pennsylvania

  https://www.pa.gov/agencies/health/diseases-conditions/lupus.html

  Early detection, treatment, and patient education help to control lupus. […] Learn how to tell if a flare is coming and contact your health care provider right away. Warning signs of a flare may include: […] See your health care provider regularly and go over your treatment plan to make sure it is working for you. […] Limit the time you spend in the sun and in fluorescent and halogen light. […] Maintain a healthy diet. […] Get enough sleep and rest. […] Include a moderate amount of physical activity when possible. […] Develop a support system made up of people you trust and can go to for help.

• #10 5 Foods and Medications to Avoid If You Have Lupus : Johns Hopkins

  https://www.hopkinslupus.org/lupus-info/lifestyle-additional-information/avoid/

  People with lupus should avoid the sun, since sunlight can cause rashes and flares. […] It is very important that you avoid Bactrim and Septra, because these antibiotics are known to cause an increase in sun sensitivity and lower blood counts in people with lupus, resulting in lupus flares. […] People with lupus and lupus-like signs should avoid cooking with garlic and adding it to food. […] People with lupus and similar autoimmune conditions should avoid alfalfa sprouts completely. […] People with lupus and other autoimmune diseases should avoid these supplements.

• #11 Systemic Lupus Erythematosus (SLE) Treatment & Management: Approach Considerations, Pivotal and New Lupus Therapies, Emergency Department Management

  https://emedicine.medscape.com/article/332244-treatment

  Patients with SLE should be educated to avoid triggers for flare. Persons with SLE should avoid ultraviolet light and sun exposure to minimize worsening of symptoms from photosensitivity. Diet modification should be based on the disease activity. A balanced diet is important, but patients with SLE and hyperlipidemia, for example, should be placed on a low-fat diet. Many patients with SLE have low levels of vitamin D because of less sun exposure; therefore, these patients should take vitamin D supplements. Exercise is important in SLE patients to avoid rapid muscle loss, bone demineralization, and fatigue. Smoking should also be avoided. […] Antimalarial therapy (hydroxychloroquine) has been shown to prevent disease flares and to decrease mortality. […] Contraception and family planning are important considerations given the risks of disease flare with exogenous estrogens and pregnancy and with the teratogenic risks of some SLE drugs. Estrogen therapies have typically been avoided to prevent disease flares; progesterone-only contraception is more often considered.

• #12 The Expert Series: Managing and preventing flares | Lupus Foundation of America

  https://www.lupus.org/resources/the-expert-series-managing-and-preventing-flares

  Some examples of lupus triggers include the following ultraviolet light is one of the most well known triggers of lupus flares. […] It is mandatory that people who have lupus never smoke and do everything in their power to stop smoking if they are smoking cigarettes is a guaranteed is a guaranteed way to make lupus worse and cause a premature death. […] If you plan to add herbs, dietary supplements or vitamins to your diet, you should discuss this decision with your lupus doctor first. […] Stress can trigger lupus to be more active. […] Low vitamin D can trigger can trigger increased lupus inflammation, because when there is a lack of vitamin D in the body, the immune system works improperly. […] One of the most common causes of people having lupus flares is simply from not taking their medicines regularly.

• #13 Lupus Basics | Lupus | CDC

  https://www.cdc.gov/lupus/about/index.html

  There is no cure for lupus, but it can be treated. […] The earlier you can diagnose lupus, the better you can treat and manage it. […] To best manage your symptoms, it is important to: See a doctor regularly. […] The goals of treatment are to: Manage the symptoms you have. […] Prevent future increases in symptoms (flares). […] Stop or delay damage to joints and organs. […] Reduce inflammation. […] Certain things can worsen lupus, increasing flares and possibly a person’s risk of death.

• #14 How To Prevent Lupus

  https://www.health.com/lupus-prevention-7105174

  Lupus is a chronic (long-lasting) autoimmune disease that affects the skin, lungs, kidneys, joints, muscles, and heart. Like other autoimmune conditions, the direct cause of lupus is unknown and the condition is not preventable. […] If you do receive a diagnosis for lupus, some preventative measures can reduce how often you experience lupus flares or periods where you experience active symptoms. A variety of lifestyle factors, such as diet and environmental exposure, can help you lower your risk of a flare-up. […] Researchers believe that early intervention during the preclinical lupus stage can delay or even prevent the transition to classified lupus for some people. […] These early interventions can help you and your provider closely monitor your condition. Although more research is needed for people in the preclinical lupus stage, following these suggestions can help you lower your risk of developing a formal lupus diagnosis and prevent complications from occurring.

• #15 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus | Annals of the Rheumatic Diseases

  https://ard.bmj.com/content/78/6/736

  Our objective was to update the EULAR recommendations for the management of systemic lupus erythematosus (SLE), based on emerging new evidence. […] Treatment in SLE aims at remission or low disease activity and prevention of flares. […] Patients with SLE should be assessed for their antiphospholipid antibody status, infectious and cardiovascular diseases risk profile and preventative strategies be tailored accordingly. […] Prevention of disease flares is an additional milestone of SLE treatment. […] Assessment of adherence to drug treatment, close monitoring and optimisation of disease control in these patients may reduce the risk for a flare. […] Hydroxychloroquine (HCQ) is recommended for all patients with SLE. […] GC can provide rapid symptom relief, but the medium to long-term aim should be to minimise daily dose to 7.5 mg/day prednisone equivalent or to discontinue them, because long-term GC therapy can have various detrimental effects including irreversible organ damage.

• #16 Systemic Lupus Erythematosus: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0400/systemic-lupus-erythematosus.html

  Hydroxychloroquine is recommended for all patients with SLE to prevent flare-ups, organ damage, and thrombosis and increase long-term survival. […] Management of SLE is directed at achieving complete remission or low disease activity, minimizing the use of glucocorticoids, preventing flare-ups, and improving quality of life. […] Hydroxychloroquine should be continued during pregnancy because it has been shown to control disease activity. It may reduce pregnancy complications, including preeclampsia and cardiac neonatal lupus. […] Preconception counseling regarding risks, planning the timing of pregnancy, and a multidisciplinary approach play a major role in the management of SLE in patients contemplating pregnancy. […] Patients with chronic kidney disease should receive one dose of pneumococcal conjugate vaccine (PCV20 or PCV15). When PCV15 is used, it should be followed by a dose of pneumococcal polysaccharide vaccine (PPSV23). […] Screening for nephritis with urinalysis and serum creatinine levels should be done at three- to six-month intervals in all patients with SLE. […] Hydroxychloroquine use during pregnancy is associated with a reduced risk of fetal development of cardiac neonatal lupus.

• #17 Hydroxychloroquine (Plaquenil): Benefits, Side Effects, and Dosing | Lupus Foundation of America

  https://www.lupus.org/resources/drug-spotlight-on-hydroxychloroquine

  In 1956, the U.S. Food and Drug Administration approved HCQ for symptoms of lupus and rheumatoid arthritis, particularly skin inflammation, hair loss, mouth sores, fatigue, and joint pain. […] Research into the wide-ranging effects of hydroxychloroquine has revealed many important benefits in the treatment of lupus; it must be noted that these benefits may be less effective in people who smoke. Benefits include: […] Strong evidence of prevention of disease flares. […] Hydroxychloroquine was previously prescribed only for people whose lupus disease activity was mild in its course; if the lupus became active, steroids or immunosuppressants would be prescribed instead. Today, however, HCQ is recommended for most individuals with lupus, whether mild, moderate, or severe, as well as during pregnancy and while breastfeeding. Given the drugs many and varied beneficial effects and its excellent long-standing safety profile, most rheumatologists believe that hydroxychloroquine should be taken by people with lupus throughout their lifetime. Annual examinations with a qualified retina specialist are strongly encouraged, however.

• #18 Longterm Hydroxychloroquine Therapy and Low-dose Aspirin May Have an Additive Effectiveness in the Primary Prevention of Cardiovascular Events in Patients with Systemic Lupus Erythematosus | The Journal of Rheumatology

  https://www.jrheum.org/content/44/7/1032

  Objective. Systemic lupus erythematosus (SLE) is associated with an increased risk of cardiovascular disease (CVD). Thromboprophylaxis with low-dose aspirin (ASA) and hydroxychloroquine (HCQ) seems promising in SLE. We investigated the effects of HCQ cumulative dosages (c-HCQ) and the possible synergistic efficacy of ASA and HCQ in preventing a first CV event (CVE) in patients with SLE. […] Our results suggest that prolonged use of HCQ plus ASA is thromboprotective in SLE and provides additional evidence for its continued use in patients with SLE. […] Low-dose aspirin (ASA) is advocated for the primary prophylaxis of thrombosis in patients with SLE, especially in those with triple antiphospholipid antibody (aPL) positivity, lupus anticoagulant (LAC) positivity, or isolated persistent anticardiolipin antibodies (aCL) at medium-high titers, whereas hydroxychloroquine (HCQ) has been shown to reduce certain traditional CV risk factors (e.g., hyperlipidemia and diabetes) and prevent thrombosis in patients with SLE.

• #19 Longterm Hydroxychloroquine Therapy and Low-dose Aspirin May Have an Additive Effectiveness in the Primary Prevention of Cardiovascular Events in Patients with Systemic Lupus Erythematosus | The Journal of Rheumatology

  https://www.jrheum.org/content/44/7/1032

  We recently reported that ASA may be effective in the primary prevention of thrombosis in patients with SLE. […] Our present analysis was performed to evaluate the role of HCQ cumulative dosages (c-HCQ) and the possible synergistic efficacy of ASA and HCQ therapies in the primary prevention of CV events (CVE) in patients with SLE. […] Kaplan-Meier analysis revealed a significant difference in CVE-free rates among the 4 subgroups of patients. […] At multivariate analysis, c-HCQ 600 g independently and significantly reduced the incidence of CVE. This protective effect could be related to the immune-modulatory properties (e.g., reduction of the formation of aPL2-glycoprotein I complexes to phospholipid bilayers and inhibition of oxidative stress) that HCQ exerts in the endothelial microenvironment.

• #20 Session to Examine Potential for Lupus Disease Modification and Prevention – ACR Convergence Today

  https://www.acrconvergencetoday.org/session-to-examine-potential-for-lupus-disease-modification-and-prevention/

  Session to Examine Potential for Lupus Disease Modification and Prevention […] The concept of disease modification has been well-established in rheumatoid arthritis and other chronic diseases, but not in lupus. […] Dr. Askanase will discuss whether the drugs currently used to treat lupus can be classified as disease-modifying agents during Lupus Prevention and Disease-Modifying Anti-Lupus Drugs (DMALDs), Are We There Yet? […] She was part of a task force convened in 2022 to establish the framework for disease modification in systemic lupus erythematosus (SLE). […] Long-term outcomes — the prevention or slowdown of the progression of damage — should be demonstrated at five years and beyond, they determined. […] David Karp, MD, PhD, Professor and Chief of the Rheumatic Diseases Division at the University of Texas Southwest Medical Center and Past President of the ACR (2020–2021), will discuss whether lupus can be prevented. […] Dr. Karp has been investigating a National Institutes of Health (NIH)-supported clinical trial using hydroxychloroquine to prevent lupus in people at risk. […] In the meantime, we have learned a lot about prevention of lupus in people with few or no symptoms.

• #21 Can Lupus Be Prevented? Research Reveals Clues to Who’s Most Likely to Transition to Classified Disease – Page 4 of 7 – The Rheumatologist

  https://www.the-rheumatologist.org/article/can-lupus-be-prevented-research-reveals-clues-to-whos-most-likely-to-transition-to-classified-disease/4/?singlepage=1

  Lupus researchers want to identify any potential early interventions that may prevent disease onset in at-risk individuals. […] Hydroxychloroquine treatment prior to SLE diagnosis was also associated with a longer mean time between first clinical symptom onset and diagnosis. […] This multi-center, randomized, placebo-controlled, double-blind, parallel group, 36-month clinical trial will evaluate the efficacy and safety of hydroxychloroquine intervention to prevent autoantibody accrual and future onset of clinically apparent SLE.

• #22 Infections in the lupus patient: perspectives on prevention – PubMed

  https://pubmed.ncbi.nlm.nih.gov/21532484/

  Infections are one of the most common causes of morbidity, hospitalization and death in patients with systemic lupus erythematosus (SLE). The aim of the review is to describe an approach to screening and prevention of infections in patients with SLE based on recent evidence. […] We recommend screening for infectious comorbidities such as tuberculosis and viral hepatitis at the first clinical encounter in patients with lupus in addition to recommending pneumococcal vaccination and yearly influenza vaccination. There is currently limited evidence to support antibiotic prophylaxis for SLE patients on immunosuppressive agents to prevent penumocystis or to support screening for cytomegalovirus and further study is required. Lastly, timely antibiotic treatment in patients with lupus who are hospitalized with infectious complications is important, as delayed antibiotic treatment may be associated with increased mortality.

• #23 Patient education: Systemic lupus erythematosus (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/systemic-lupus-erythematosus-beyond-the-basics

  Avoiding smoking — Cigarette smoking has been associated with symptom flares in people with lupus and has many other negative health effects. Quitting smoking is difficult, but your health care provider can help. […] Vaccines — Vaccines to prevent pneumonia, influenza (the flu), and coronavirus disease 2019 (COVID-19) are recommended for people with lupus. Some people should also get the shingles vaccine. […] Fortunately, treatments to prevent or minimize lupus-related kidney disease are available. […] […] Your doctors can guide you on how to maximize your chances of having a healthy pregnancy and baby. In most cases, a person should wait until their lupus has been under control (ie, no flares) for at least six months before trying to get pregnant.

• #24 Should Lupus Nephritis Receive PJP Prophylaxis? | RheumNow

  https://rheumnow.com/news/should-lupus-nephritis-receive-pjp-prophylaxis

  A current review article suggests that the need for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in patients with systemic lupus erythematosus (SLE) and lupus nephritis will need to be individualized based on therapies and risk factors. […] There are no clear guidelines for PJP prophylaxis in SLE and LN. But added use of immunosuppressive medications and systemic corticosteroids may change this consideration, especially since patients with autoimmune disease and PJP may have an estimated mortality of 40% to 50%. […] SLE has a low risk of PJP infection, suggesting prophylaxis is not generally warranted. Moreover the use antibiotic prophylaxis (trimethoprim-sulfamethoxazole), is associated with more than 10% risk of side effects (rash, drug allergy, cytopenias, disease flares). […] The review authors suggest a „more targeted or conditional approach” wherein one weights TMP/SMZ harms vs risk of PJP. Risk factors for PJP infection that may warrant prophylaxis include: low absolute lymphocyte count (no consensus exists yet on the exact threshold), low CD4+ count (200 cells/mm3), presence of concomitant structural lung disease. […] With the new 2024 ACR guidelines for LN (class III/IV) calling for triple therapy (steroids, MMF, voclosporin or belimumab), PJP risk needs to be considered. Other known, and important risk factors for PJP include the use of high dose steroids and rituximab.

• #25 Should Patients Receiving Induction for Lupus Nephritis Receive PJP Prophylaxis? An Opportunistic Discussion Between Nephrology and Rheumatology in: Kidney News Volume 17 Issue 4 (2025)

  https://www.kidneynews.org/view/journals/kidney-news/17/4/article-p16_7.xml

  Pneumocystis jirovecii pneumonia (PJP) is a serious opportunistic fungal infection in patients with compromised or suppressed immune systems. […] While clear guidelines exist for the use of PJP prophylaxis in those with underlying malignancy and in solid organ transplant recipients, there are no published consensus guidelines for patients with rheumatologic diseases receiving immunosuppressive medications, including those with systemic lupus erythematosus (SLE). […] Thus, there is strong crosstalk and collaboration between nephrologists and rheumatologists when caring for this patient population. […] Among rheumatologists, this movement has lent itself to increasing literature and discussion regarding the indications for and appropriateness of a routine PJP prophylaxis prescription in patients with SLE undergoing induction therapy.

• #26 Should Patients Receiving Induction for Lupus Nephritis Receive PJP Prophylaxis? An Opportunistic Discussion Between Nephrology and Rheumatology in: Kidney News Volume 17 Issue 4 (2025)

  https://www.kidneynews.org/view/journals/kidney-news/17/4/article-p16_7.xml

  A pivotal Cochrane Database of Systematic Reviews in 2014 concluded that PJP prophylaxis is warranted when the risk of infection exceeds 6%, which corresponds to a number needed to treat (NNT) of approximately 20. […] In the case of SLE, recent data have consistently suggested a low infection rate. […] Studies considering both those who do and do not receive prophylaxis have demonstrated a relatively low incidence, on the order of two per every 1000 person-years, when all patients with SLE are considered in aggregate. […] In the field of rheumatology, there is a growing movement toward conditional prescription of PJP prophylaxis in patients with SLE, based on risk factors associated with a lower NNT weighed against potential adverse effects from added medications. […] Specific conditions that appear to increase the risk of infection and warrant prophylaxis include low absolute lymphocyte count, low CD4+ count, and presence of concomitant structural lung disease.

• #27 Clinical practice pattern of Pneumocystis pneumonia prophylaxis in systemic lupus erythematosus: a cross-sectional study from lupus registry of nationwide institutions (LUNA) | Arthritis Research & Therapy | Full Text

  https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-024-03434-2

  Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection in patients undergoing immunosuppressive therapy, such as glucocorticoid (GC) medication, for systemic autoimmune diseases like systemic lupus erythematosus (SLE). Despite the confirmed effectiveness of PCP prophylaxis, its clinical administration, especially in conjunction with GC dosage, remains unclear. […] We aimed to describe the clinical practice of PCP prophylaxis in association with SLE in Japan, evaluate the relationship between GC dosage and PCP prophylaxis, and explore the practice patterns associated with PCP prophylaxis. […] Out of 1,460 patients, 21% underwent PCP prophylaxis. The frequency of prophylaxis decreased with a decrease in GC dosage. After adjusting for confounders, logistic regression revealed the odds ratio of PCP prophylaxis increased with higher prednisolone (PSL) doses: 3.7 for 5PSL7.5 mg, 5.2 for 7.5PSL10 mg, 9.0 for 10PSL20 mg, and 43.1 for PSL20 mg, using PSL5 mg as the reference. […] This study provides valuable insights into PCP prophylaxis practices in patients with SLE in Japan, underscoring the importance of GC dosage and concomitant immunosuppressant use.

• #28 Clinical practice pattern of Pneumocystis pneumonia prophylaxis in systemic lupus erythematosus: a cross-sectional study from lupus registry of nationwide institutions (LUNA) | Arthritis Research & Therapy | Full Text

  https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-024-03434-2

  PCP prophylaxis was performed in 293 patients (21%), and the medications included TMP/SMX in 266 patients, atovaquone in 23, and pentamidine in 4. […] The proportion of the patients who underwent PCP prophylaxis decreased with decreasing GC dosage: Group 5 (PSL20 mg), 52/76 (68%); Group 4 (10PSL20 mg), 81/226 (36%); Group 3 (7.5PSL10 mg,) 47/180 (26%); Group 3 (5PSL7.5 mg), 91/519 (18%); and Group 4 (5 mg), 21/454 (5%). […] Even after adjusting for confounders, the GC dosage remained associated with PCP prophylaxis, and decision tree analysis identified GC dosage and immunosuppressant use as determining factors influencing PCP prophylaxis. […] Concomitant use of immunosuppressants is also an important determinant of PCP prophylaxis. Given the risk of PCP associated with the concomitant use of GCs and immunosuppressants, PCP prophylaxis is recommended for patients receiving GCs, especially those receiving concomitant immunosuppressants. […] This study elucidates the patterns of PCP prophylaxis in patients with SLE, highlighting a significant association with GC dosage and the concomitant use of immunosuppressants.

• #29 Systemic Lupus Erythematosus (SLE) Treatment & Management: Approach Considerations, Pivotal and New Lupus Therapies, Emergency Department Management

  https://emedicine.medscape.com/article/332244-treatment

  Preventive measures are necessary to minimize the risks of steroid-induced osteoporosis and accelerated atherosclerotic disease. […] The American College of Rheumatology (ACR) guidelines for the prevention of glucocorticoid-induced osteoporosis suggest the use of traditional measures (eg, calcium, vitamin D) and the consideration of prophylactic bisphosphonate therapy. […] The ACR Quality of Care statement recommends annual cardiovascular disease risk assessment; some researchers suggest that the cardiovascular risk for SLE is similar to that for diabetes mellitus. […] Angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin receptor blockers may be useful in patients with kidney disease. Aggressive blood pressure and lipid goals may help prevent progression of cardiovascular or kidney disease. […] The European League Against Rheumatism (EULAR) vaccination recommendations for rheumatic diseases, including lupus, advocate baseline assessment and delivery of nonlive vaccines during stable disease.

• #30

  https://link.springer.com/article/10.1007/s10753-021-01455-6

  Systemic lupus erythematosus (SLE) carries a significant risk of cardiovascular disease (CVD). […] Despite the overall headway that has been achieved in treating lupus, innovative therapeutics specifically targeting the progression of atherosclerosis within the lupus population are currently lacking. […] Due to the significant impact of CVD on morbidity and mortality, research addressing prevention and treatment of CVD in SLE needs to be prioritized. […] This review explores the intricate interplay of SLE-specific properties that contribute to atherosclerosis and CVD within this population, as well as screening methods and possible therapies. […] Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review. […] Longterm hydroxychloroquine therapy and low-dose aspirin may have an additive effectiveness in the primary prevention of cardiovascular events in patients with systemic lupus erythematosus.

• #31 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus | Annals of the Rheumatic Diseases

  https://ard.bmj.com/content/78/6/736

  Consequent initiation of IS drugs facilitates a more rapid GC tapering and may prevent disease flares. […] The choice of agent depends on prevailing disease manifestation(s), patient age and childbearing potential, safety concerns and cost. […] There is evidence to support beneficial effects of B-cell targeting agents in SLE. […] Belimumab should be considered in extrarenal disease with inadequate control (ongoing disease activity or frequent flares) to first-line treatments. […] Patients with SLE with cerebrovascular disease should be managed like the general population in the acute phase; in addition to controlling extra-CNS lupus activity, IS therapy may be considered in the absence of aPL antibodies and other atherosclerotic risk factors or in recurrent cerebrovascular events. […] Risk of infection in SLE is associated with both disease-related and treatment-related factors; high-dose GC therapy, CYC, MMF and RTX are all associated with an increased risk for infection. […] Protection against infections should be proactive, focusing both on primary prevention, as well as timely recognition and treatment. […] Low-dose aspirin may be considered for primary prevention of CVD, as it may reduce the risk for incident CVD in SLE.

• #32 Systemic lupus erythematosus secondary prevention – wikidoc

  https://www.wikidoc.org/index.php/Systemic_lupus_erythematosus_secondary_prevention

  Secondary prevention strategies following systemic lupus erythematosus include using aspirin, ACE inhibitors, and statins to reduce atherosclerotic diseases, and using cancer screenings. […] Aims of secondary prevention measures for SLE include: Preventing glucocorticoid usage and using the minimum dosage to prevent osteonecrosis and osteoprosis side effects. […] Decreasing atherosclerotic events in patients: Low doses of aspirin, ACE inhibitors, Statins. […] For prevention and/or early diagnosis of malignancies: Regular age-related specific cancer screening recommended for the general population.

• #33 Article: Statins for prevention of cardiovascular disease in systemic lupus erythematosus (full text) – April 2017 – NJM

  https://njmonline.nl/article_ft.php?a=1827&d=1212&i=204

  Statins for prevention of cardiovascular disease in systemic lupus erythematosus […] Given the high burden of CVD-related morbidity and mortality in SLE, prevention of these complications could result in a robust health benefit. […] Lupus patients are even more at risk for CVD than RA patients, with a standardised mortality ratio for CVD of 2.7 compared with 1.5-1.8 in RA. […] Therefore, our aim was to review the evidence on the use of statins for prevention of CVD in SLE patients and provide a recommendation for future management. […] In conclusion, the use of statins was associated with a large decrease in CVD and mortality, although causality still has to be proven. […] These findings provide a reasonable basis to support strict guidelines for statin therapy for SLE patients with an increased risk of CVD. […] Since the risk of CVD in SLE patients surpasses that in RA patients, we highly recommend that SLE patients should be treated according to the current EULAR recommendations for cardiovascular risk management in rheumatoid arthritis.

• #34 Osteoporosis screening, prevention, and treatment in systemic lupus erythematosus: application of the systemic lupus erythematosus quality indicators. | Rheumatology

  https://rheumatology.ucsf.edu/node/3686

  Osteoporosis and fragility fractures are associated with significant morbidity for patients with systemic lupus erythematosus (SLE). New quality indicators (QIs) for SLE advise bone mineral density testing, calcium and vitamin D use, and antiresorptive or anabolic treatment for specific subgroups of patients receiving high-dose steroids. […] Quality improvement efforts should address osteoporosis prevention and care among all SLE patients, especially those receiving high-dose, prolonged steroids.

• #35 Lupus treatments & disease management: Current options | HSS

  https://www.hss.edu/conditions_managing-treating-lupus.asp

  The overarching objective is to preserve a normal lifespan without disabilities. […] Indirect goals of lupus management include the prevention of hospitalizations and emergency room visits, the control of disabling symptoms such as pain and fatigue, and the preservation of functionality such as continued attendance at (or a return to) work and/or school. […] Early therapeutic intervention is needed to minimize damage from uncontrolled disease. […] Examples of such interventions include the control of cardiovascular disease risk factors (such as high blood pressure, high cholesterol), repletion of calcium/vitamin D to protect bones, and vaccination for influenza and pneumonia to prevent infection. […] It is important that patients adopt lifestyle habits that will facilitate best outcomes with their doctors approval. Key habits include the following: staying informed about lupus, keeping doctors appointments, taking medication, following a healthy eating pattern, quitting smoking, getting aerobic exercise, receiving pregnancy/contraception counseling, developing strategies to effectively manage stress, participating in social support groups.

• #36 Lupus | National Kidney Foundation of Michigan

  https://nkfm.org/conditions/lupus/

  Lupus is a chronic disease that can cause inflammation and pain in any part of your body. […] Lupus nephritis is a type of kidney disease caused by lupus. […] The treatments for lupus nephritis include immunosuppressive drugs (medicines that partly turn off the immune system) and medicines that can help with kidney damage called ACE inhibitors or ARBs. […] Diet changes for lupus nephritis may include reducing salt and protein and eating lower fat, heart healthy foods. […] Low impact exercise, such as walking and swimming, may have physical and emotional benefits for people with lupus nephritis (check with your doctor before starting an exercise plan). […] Lupus is a high-risk factor for kidney disease, particularly Lupus Nephritis.

• #37 Is Lupus Contagious? Strategies for Identification and Prevention

  https://revivalresearch.org/blogs/is-lupus-contagious/

  Lupus is not transmissible from one person to another, not even through intimate contact or sexual activity. […] The answer to whether is lupus contagious or not, is, it is not! Individuals cannot transmit the condition through skin contact, blood, sweat, saliva, or any other means. […] While the exact cause of lupus still remains unclear, the question of whether is lupus contagious has the same answer, which is no. […] Understanding whether is lupus contagious or not, and recognizing its symptoms, can help in identifying suitable preventive strategies and managing the autoimmune condition effectively. […] Limit Sunlight Exposure It is suggested by Dermatologists at Revival, to minimize direct sunlight exposure if it induces a rash. Using a sunscreen with an SPF of 70 or higher, effectively blocking both UVA and UVB rays. Avoid Certain Medications Avoiding certain medications such as antibiotics like trimethoprim-sulfamethoxazole (Bactrim) and mis linocycline (Minocin), which can increase sensitivity to sunlight. Proper Stress Management It is essential to develop stress management strategies such as engaging in activities like yoga, meditation or even receiving massages which can help in soothing the mind. Get Adequate Sleep It is important to go to bed early enough every night to at least have seven to eight hours of proper rest.

• #38 Lupus: Treatment, living with lupus, and prevention

  https://www.medicalnewstoday.com/articles/323665

  People with lupus might find that they make symptoms worse, according to the Johns Hopkins Lupus Center. […] People should avoid these as far as possible. […] In developing a treatment plan, the doctor will aim to: prevent flares. […] Hydroxychloroquine helps to reduce pain and inflammation, prevents flares, and allows people to reduce their dose of other lupus medications. […] A person with lupus should avoid the following: smoking, becoming overtired, unplanned pregnancy it is important to adjust lupus medications at least 6 months before falling pregnant to avoid harming a fetus, stress, sun exposure without sunscreen. […] In the past, lupus was often deadly, but current treatment can relieve symptoms and delay the start of complications, increasing the chance for a normal lifespan.

• #39

  https://link.springer.com/article/10.1007/s11926-023-01109-6

  Discuss the prognostic significance of kidney flares in patients with lupus nephritis, associated risk factors, and possible preventative strategies. […] In this respect, non-randomized and randomized evidence have suggested a number of factors associated with reduced risk of renal flares such as attaining a very low level of proteinuria (700800 mg/24 h by 12 months), using mycophenolate over azathioprine, adding belimumab to standard therapy, maintaining immunosuppressive/biological treatment for at least 3 to 5 years, and using hydroxychloroquine. […] Importantly, we discuss strategies that can potentially facilitate durable renal response thus, improving long-term outcomes. […] To this end, a variety of demographic, clinical, immunological, histological, and other parameters have been linked to an augmented risk for LN flares.

• #40 Treatment of systemic lupus erythematosus

  https://australianprescriber.tg.org.au/articles/treatment-of-systemic-lupus-erythematosus.html

  For non-renal manifestations such as arthritis and rash where hydroxychloroquine or topical corticosteroids are insufficient, methotrexate is effective. […] Mycophenolate is effective in non-renal disease that is refractory to corticosteroids, and is superior to azathioprine. […] For systemic lupus with kidney involvement, mycophenolate is superior to azathioprine so it is first-line maintenance therapy when tolerated. […] The role of biologic drugs is an area of ongoing research.

• #41

  https://link.springer.com/article/10.1007/s11926-023-01109-6

  The EULAR together with the ERA-EDTA have proposed that treatment should aim at a reduction of proteinuria by 25% by 3 months, 50% by 6 months, and to below 0.5-0.7 g/24 h by 12 months, all coupled with stable/improved eGFR (within 10% of baseline value). […] Notably, the earlier these targets are attained, the better the kidney outcomes. […] The use of antimalarials was protective against renal flares (HR: 0.66; 95% CI: 0.55-0.78). […] The presence of histological activity (AI2) especially endocapillary proliferation could predict the risk of renal flare independent of other clinical predictors. […] A paradigm shift in the care of SLE is that, in addition to acute control of inflammation, disease stabilization and prevention of flares are critical to reduce patient exposure to glucocorticoids and preserve organ function.

• #42 Neonatal and Pediatric Lupus Erythematosus Treatment & Management: Approach Considerations, Prevention and Long-Term Monitoring

  https://emedicine.medscape.com/article/1006582-treatment

  Observe mothers with positive autoantibodies and/or mothers who give birth to a child with neonatal lupus erythematosus (NLE). […] Therefore, carefully monitor subsequent pregnancies with serial ultrasonography and echocardiography, particularly at 18-24 weeks gestation. […] Fluorinated systemic steroids may help prevent NLE. […] Consult an obstetrician with experience with high-risk pregnancies, and consider administration of prednisolone or fluorinated steroids during subsequent pregnancies to prevent NLE. […] Patients with NLE and cardiac involvement require regular monitoring to assess cardiac function and the need for a pacemaker. […] Patients with cutaneous NLE do not require monitoring after lesions resolve.

• #43 Hydroxychloroquine under scrutiny for cardiac neonatal lupus prevention | MDedge

  https://blogs.the-hospitalist.org/content/hydroxychloroquine-under-scrutiny-cardiac-neonatal-lupus-prevention

  Positive signs from the nearly completed first stage of a prospective prevention trial for cardiac neonatal lupus are giving investigators hope that hydroxychloroquine can reduce the risk of fetal heart block if given during pregnancy to women with systemic lupus erythematosus who have previously had a child with the condition. […] HCQ treatment will be considered efficacious if fewer than 6 mothers of the 54 total have a child with advanced congenital heart block. […] „We need prophylactic treatment for autoimmune-associated congenital heart block because of the significant morbidity and mortality. The fibrosis is immutable, and there is no sustained reversal of complete heart block,” Dr. Buyon said at the meeting sponsored by NYU. […] Research leading up to the PATCH study indicated that HCQ might reduce the risk of CNL by 65% when pregnant mothers with SLE took HCQ throughout their pregnancy, Dr. Buyon said.

• #44 Understanding the Concept of Pre-Clinical Autoimmunity: Prediction and Prevention of Systemic Lupus Erythematosus: Identifying Risk Factors and Developing Strategies Against Disease Development – PubMed

  https://pubmed.ncbi.nlm.nih.gov/35720390/

  There is growing evidence that preceding the diagnosis or classification of systemic lupus erythematosus (SLE), patients undergo a preclinical phase of disease where markers of inflammation and autoimmunity are already present. […] By gaining a greater understanding of the pathogenesis of preclinical SLE, we can potentially identify patients earlier in the disease course who are at-risk of transitioning to full-blown SLE and implement preventative strategies. […] In this review, we discuss the current state of knowledge of SLE preclinical pathogenesis and propose a screening and preventative strategy that involves the use of promising biomarkers of early disease, modification of lifestyle and environmental risk factors, and initiation of preventative therapies, as examined in other autoimmune diseases such as rheumatoid arthritis and type 1 diabetes.

• #45 Can Lupus Be Prevented? Research Reveals Clues to Who’s Most Likely to Transition to Classified Disease – Page 4 of 7 – The Rheumatologist

  https://www.the-rheumatologist.org/article/can-lupus-be-prevented-research-reveals-clues-to-whos-most-likely-to-transition-to-classified-disease/4/?singlepage=1

  Is it possible to identify preclinical signs of systemic lupus erythematosus (SLE) very early and intervene to prevent a patients transition to active disease? […] Researchers are searching for interventions that may eliminate lupus, said Dr. James. To reach that goal, we have to better understand these early events and how we can stop the process before its too late. This will require better preclinical cohorts, better understanding of early pathogenesis and predictors of transition. […] Clinical rheumatologists who receive questions about lupus risk from family members should stress that most relatives will not transition to disease. If you have family members who are really stressed about whether they will develop lupus, or if they have a positive ANA or some clinical feature, we can share lifestyle choices that may help them, based on data that these may be associated with lupus transition and are good ideas for your health anyway, such as quitting smoking, getting adequate sleep, ensuring adequate vitamin D levels and maintaining ideal body weight.

• #46 The Expert Series: Managing and preventing flares | Lupus Foundation of America

  https://www.lupus.org/resources/the-expert-series-managing-and-preventing-flares

  It is difficult to get into a daily life habit such as wearing sunscreen every day. If you do not know the reasons behind why it is important to do so. […] Lastly, make sure to have a flare plan in place with your doctor. Knowing what to do when you have a flare is as important as preventing flares in the first place. […] Identifying and treating the flare as soon as possible are very important.

• #47 Lupus | Lupus Symptoms | SLE | MedlinePlus

  https://medlineplus.gov/lupus.html

  Lupus is a chronic (long-lasting) type of autoimmune disease. Autoimmune diseases happen when your immune system attacks healthy cells and tissues by mistake. This attack causes inflammation. It can also damage many parts of the body, including the joints, skin, kidneys, heart, lungs, and brain. […] There is no cure for lupus, but medicines and lifestyle changes can help control it. […] The goals of a treatment plan are to: Prevent flares, Treat flares when they occur, Reduce organ damage and other problems, Improve your quality of life. […] Treatments may include drugs to: Reduce fever, swelling, and pain, Reduce inflammation in your body, Prevent or reduce flares, Reduce or prevent damage to joints, Suppress (lower) the activity of your immune system. […] It is important to take an active role in your treatment. It helps to learn more about lupus – being able to spot the warning signs of a flare can help you prevent the flare or make the symptoms less severe.

• #48 Lupus treatments & disease management: Current options | HSS

  https://www.hss.edu/conditions_managing-treating-lupus.asp

  Treatment aims to control lupus by suppressing the overactive immune system just enough without risking compromise of the body’s defenses against infection or tumors. […] Lupus patients who partner with their doctors on their medical treatment plan and who adopt healthy lifestyle behaviors have the best chance for a normal lifespan free of disabilities.

• #49 Lupus Flares: Triggers, Prevention, and Management | MyLupusTeam

  https://www.mylupusteam.com/resources/flare-triggers-and-lupus

  The best way to prevent lupus flares is to avoid known triggers. However, this is much easier said than done with some triggers. […] Finding an effective treatment for lupus is another way to prevent at least some flare-ups. When your immune system is better controlled, flares are less likely. […] To help keep your lupus under control, your rheumatology team may prescribe: Antimalarial drugs like hydroxychloroquine (Plaquenil), Corticosteroids like prednisone, Nonsteroidal anti-inflammatory drugs (NSAIDs), Immunosuppressants, Biologics. […] Most of the time, controlling lupus and preventing flares comes down to having the right plan. Work with your rheumatologist to create a treatment plan that works best for you. Often, that involves taking medication, getting plenty of physical and emotional rest, eating a balanced and healthy diet, engaging in moderate exercise, avoiding known triggers, treating any infections, and managing stress.

• #50 Lupus

  https://phoenixchildrens.staywellsolutionsonline.com/Search/85,P00058

  Lupus has no known cure, but medicines may help manage symptoms. You can help manage lupus by living a healthy lifestyle and working with your health care provider. […] The goals of treatment include treating symptoms, preventing flare-ups of lupus, and helping reduce damage to the body. […] Your provider may give you medicine to help treat symptoms. Medicines can’t cure lupus, but they can help prevent organ damage or suppress the disease. […] Lupus can also be managed by keeping a healthy lifestyle. Here are ways to take care of yourself: […] Work with your provider to manage your lupus. Get regular checkups and tests. […] Children with lupus should not get vaccines with live viruses. This includes chickenpox, measles-mumps-rubella, and oral polio vaccines. Talk with your child’s provider about all vaccines. […] There is no known cure for lupus, but medicines and lifestyle changes can help you manage symptoms of the disease.

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