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Dedicated to increasing awareness about
systemic lupus erythematosus (SLE), disease activity and related organ damage

Case Studies in Patients with SLE

SLE can present in patients in a variety of manifestations.1 It can also have a considerable impact on patients' lives — interpersonal relationships, workplace productivity, and quality of life and well-being.2

This is the place to learn more about patients with SLE. The following patients case studies are hypothetical patients and for illustrative purposes only.

The SELENA-SLEDAI can be used to objectively assess a patient's overall disease activity. It is included for the purpose of demonstrating how the variables you may already be evaluating in your clinical practice correlate with the SELENA-SLEDAI disease descriptors.

  • Signs of low disease activity but is taking glucocorticoids to prevent flares

History:

  • Diagnosed 5 years ago
  • Received an antimalarial until intolerable GI upset
  • Has occasional pain in her wrists and rashes on the face

Clinical Profile:

  • Chronic fatigue with flares of malar rash and polyarthritis in the wrists

Medication History:

  • Moderate dosage of glucocorticoid daily
  • Reducing doses of glucocorticoids results in flares
Lab Values:
Hemoglobin (g/dL) 12.2
Platelets (x109/L) 210
WBCs (x109/L) 3.9
Urinalysis Normal
Creatinine (mg/dL) 0.9
Proteinuria (g/day) 0.1
Anti-dsDNA (IU/mL) 5
Complement C3
and C4 (mg/dL)
90 and 30
Lymphocytes (x109/L) 1100

SELENA-SLEDAI SCORE: 6 points
Rash 2 points, Arthritis 4 points

  • Taking an antimalarial agent alone but is having flares requiring short-term glucocorticoids

History:

  • Diagnosed with SLE 2 years ago
  • For past 6 months, has experienced:
    • Fatigue
    • Hair loss
    • Increasing pain in her hands and fingers
    • Ulcers on her palate

Medication History:

  • Antimalarial for 2 years; moderate dosage of glucocorticoid daily for flares
Lab Values:
Hemoglobin (g/dL) 12.2
Platelets (x109/L) 260
WBCs (x109/L) 3.9
Urinalysis Normal
Creatinine (mg/dL) 1.2
Proteinuria (g/day) Normal
Anti-dsDNA (IU/mL) 40
Complement C3
and C4 (mg/dL)
60 and 5
Lymphocytes (x109/L) 1200

SELENA-SLEDAI SCORE: 12 points
Arthritis 4 points, Mucosal ulcers 2 points, Alopecia 2 points, Elevated anti-dsDNA 2 points, Low complement 2 points

History:

  • Diagnosed with SLE 8 years ago
  • Had 2 flares in the first year (joint pain in fingers), resulting in higher glucocorticoid doses
  • Higher glucocorticoid dosage has led to side effects (weight gain and swelling of the ankles)
  • Feels her disease is getting worse

Clinical Profile:

  • Persistent pain in the proximal interphalangeal joints
  • Pleurisy
  • Recurrent photosensitive discoid rash
  • Constantly tired and aching, and has rashes on her face and ears

Medication History:

  • Antimalarial agent since diagnosis; low dose glucocorticoids daily since last flare; intramuscular glucocorticoid injections as needed to control joint pain and stiffness; immunosuppressive agents.
Lab Values:
Hemoglobin (g/dL) 10.2
Platelets (x109/L) 170
WBCs (x109/L) 3.2
Urinalysis Normal
Creatinine (mg/dL) 1.2
Anti-dsDNA (IU/mL) 150
Complement C3
and C4 (mg/dL)
88 and 9
Lymphocytes (x109/L) 1100

SELENA-SLEDAI SCORE: 12 points
Arthritis 4 points, Pleurisy 2 points, Rash 2 points, Elevated anti-dsDNA titer 2 points, Low complement 2 points

  • For Denise and her healthcare providers, arriving at a diagnosis of SLE took 2 years
Date Presentation Next Steps/
Follow-Up
June 11, 2010 Patient presented with edema of ankles, fatigue Apparent effect from recent flight; advised to sleep with legs elevated
Dec 20, 2010 Patient reports joint pain, cold hands and feet, fever Flu test negative. Referred for x-ray of painful joints. Scheduled follow-up visit
Jan 20, 2011 Joint pain follow-up visit. X-ray indicates no erosion or subluxation. Patient reports all symptoms resolved Patient advised to make an appointment if symptoms return
Aug 15, 2011 Rash on cheeks and nose Referred to dermatologist
Aug 22, 2011 Dermatologist report Diagnosed with rosacea
Feb 1, 2012 Patient presented with severe abdominal pain; reports occasional fever Referred to gastroenterologist
Feb 7, 2012 Gastroenterologist report Symptoms resolved prior to visit without intervention, possible inflammatory bowel
disease
Jul 16, 2012 Patient presented with severe Raynaud phenomenon Referred to
rheumatologist
Aug 9, 2012 Rheumatologist report SLE diagnosis
  • Cheryl was diagnosed with SLE in 1998 but began to present with complications from renal disease
Date Presentation Next
Steps/Follow-Up
Apr 18, 2008 Patient presents with edema of ankles, hands, eye area; reports increased fatigue and need to urinate at night. Lab tests reveal proteinuria with hematuria and cellular casts Patient scheduled
for renal biopsy
Apr 28, 2008 Renal biopsy report Renal biopsy
indicates
class III focal lupus nephritis
Mar 16, 2009 Annual physical exam Lab tests indicate hypertension, hyperlipidemia, and insulin resistance
Nov 18, 2009 Painful frequent urination Urinary tract infection confirmed
June 22, 2010 Broken wrist from minor fall. Referred for DEXA scan Results reveal
patient has osteopenia
Jul 15, 2010 Continued edema, fatigue, headaches. Urine is foamy Lab tests reveal proteinuria with hematuria, cellular casts, elevated
serum creatinine. Renal biopsy
indicates class V membranous lupus
nephritis
Sept 24, 2010 Follow-up appointment: persistent proteinuria with hematuria, cellular casts, elevated serum creatinine. Urine is brown. Patient reports numbness in extremities, frequent vomiting Diagnosed with
end stage renal disease, placed on dialysis, added to kidney transplant
list

HOW DOES SLE AFFECT
PATIENTS' LIVES?

Flashcard highlighting data from the key literature.

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PATIENT CARE INSIGHTS

Anca Askanase, MD, discusses concerns for patients with SLE.

This promotional program was developed in conjunction with and sponsored by GSK, based on an interview with Anca D. Askanase, MD, MPH.

Dr. Askanase received a fee for participation in this program.

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SLE AND ITS IMPACT ON PATIENTS

Exploring Systemic Lupus Erythematosus
This slide deck discusses the path to diagnosis of SLE, pathogenesis of the disease, impact on patients, and how to best support patients.

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HELP YOUR PATIENTS TAKE AN ACTIVE ROLE

This thorough patient education program includes instructions, a slide deck complete with speaker's notes, and worksheets for patients.

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What Next?

Organ damage is one of the most important correlates with morbidity and mortality in SLE.1

Learn more about how SLE
impacts patients with SLE now

References:
1. American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines. Guidelines for referral and management of systemic lupus erythematosus in adults. Arthritis Rheum. 1999;42(9):1785-1796. http://www.ncbi.nlm.nih.gov/pubmed/10513791. Accessed February 14, 2017. 2. Katz P, Morris A, Trupin L, et al. Disability in valued life activities among individuals with systemic lupus erythematosus. Arthritis Rheum. 2008;59(4):465-473. http://dx.doi.org/10.1002%2Fart.23536. Accessed February 14, 2017.