Management Of Systemic Lupus ... Health Article

Maximizing Disease Control

The most important criteria for disease control are clinical outcomes. In most patients, equilibrium is reached between mild, non-life-threatening disease activity and acceptable side effects of maintenance therapies. Complete long-term disease suppression usually is not possible, especially in the absence of side effects. Acceptable clinical outcomes include stable renal function (even though proteinuria is present), safe platelet and erythrocyte levels, arthralgias without arthritis, and mild skin lesions. The efficacy of treating to normalize serum levels of complement, antibodies to DNA (or other autoantibodies), and erythrocyte sedimentation rates (ESR) is controversial. ^{77, 78, 79, 80, 81} Although disease flares are usually fewer in patients with serum complement levels and antibodies to DNA kept in the normal range, particularly in patients with nephritis, ^{77, 78, 81} a few patients with persistently low complement levels and high anti-DNA have good outcomes, ^{79, 80} and disease activity in some patients does not correlate with serum levels of any autoantibodies or of complement. ⁷⁹ It is useful to establish in each individual patient what changes in laboratory tests herald a disease flare; these tests can then be used to help guide therapy. One study shows that altering treatment in response to changes in laboratory tests significantly lowers the occurrence of disease flares. ⁸¹