Related Sites

Related Sites

medical news ireland medical news ireland medical news ireland

NOTE: By submitting this form and registering with us, you are providing us with permission to store your personal data and the record of your registration. In addition, registration with the Medical Independent includes granting consent for the delivery of that additional professional content and targeted ads, and the cookies required to deliver same. View our Privacy Policy and Cookie Notice for further details.



Don't have an account? Register

ADVERTISEMENT

ADVERTISEMENT

Advances in the management of SLE

By Priscilla Lynch - 12th Jun 2025


Reference: June 2025 | Issue 6 | Vol 11 | Page 3


Irish Society for Rheumatology, Spring Meeting

Systemic lupus erythematosus (SLE) remains a “tricky” disease, with much still to learn about its causes and the best manner of diagnosis, according to Prof David D’Cruz, Professor of Rheumatology, Guy’s and St Thomas’ Hospital, London, UK. However, according to Prof D’Cruz, significant progress has been and continues to be made in managing this disease

The good news, he told the 2025 Irish Society for Rheumatology Spring Meeting, is that there was a dramatic decline in mortality between 1971 and 2001, as demonstrated by supporting data. In the area of lupus nephritis, major advances have been achieved, including earlier diagnosis through dipstick analysis and blood pressure monitoring, improved access to care, the introduction of novel biologics, and the use of lower steroid doses.

However, he noted that many challenges remain, including difficulties in flare prevention, achieving optimal remission, and the ongoing lack of reliable non-invasive biomarkers.

A major challenge in SLE – shared by many chronic diseases – is poor medication adherence, Prof D’Cruz emphasised, citing data indicating non-adherence rates of 45-64 per cent in patients with SLE. He suggested that clinicians often underestimate the extent of medication non-adherence, which can significantly distort the assessment of treatment effectiveness.

Prof D’Cruz advised measuring the patient’s adherence independently at each check-up, as many patients state they are taking their medication when they are not and are then questioning why they are symptomatic/not improving.

“This is a huge unmet need across all of medicine, not just in rheumatology,” he told Update. There are many reasons why people don’t take their medications. For younger people, it can be denial about their disease and then others think they are doing really well so stop taking their medication. It is very complicated. I think the key is patient education but you need a lot of resources for that.”

Prof D’Cruz noted that there is no consensus on diagnostis criteria for SLE. Only classification criteria have been published by the European League Against Rheumatism (EULAR) and the American College of Rheumatology.

Neuropsychiatric lupus remains “one of the most challenging” SLE manifestations to diagnose and characterise accurately and there are currently no approved treatments, Prof D’Cruz said.

He acknowledged that the wide spectrum of neuropsychiatric symptoms and signs seen in patients with SLE makes a definitive diagnosis of neuropsychiatric lupus difficult – even in expert centres.

Attributing a specific psychiatric, neurological, or psychological symptom to lupus – rather than to a co-existing condition or medication such as corticosteroids – can be very difficult, Prof D’Cruz noted. He added that most rheumatologists rarely inquire about psychotic symptoms.

The frequency of neuropsychiatric symptoms in general is also significantly underestimated by clinicians.

“For many years, I have heard lupus patients mention nightmares as part of their lupus flares, especially if they have neuropsychiatric lupus,” he said, before discussing his research in this area.

The data suggest that nightmares and other neuropsychiatric symptoms are much more commonly experienced by SLE patients compared to matched physically healthy subjects.

Prof D’Cruz said many patients describe frightening nightmares to him involving physical threats to them or their families or alarming experiences such as relatives dying in car or aeroplane accidents or large objects hurtling towards them. He recommended asking patients suspected of having neuropsychiatric lupus about the quality of their sleep and then to ask about nightmares, ‘daymares’ and any visual, auditory, tactile, or olfactory hallucinations.

“It is underdiagnosed, under-treated, and often misdiagnosed. I think the key here is collaboration with neurologists, psychiatrists and neuropsychiatrists, and just to listen to the patient as then they will give you the diagnosis,” he said.

Looking at lupus nephritis, which manifests in close to half of SLE patients and carries a mortality rate of up to 30 per cent at 10 years, Prof D’Cruz said recurrent flares are a strong predictive factor. In 2023, EULAR updated its recommendations for the management of SLE, making three specific suggestions for the management of lupus nephritis based on the most recent available treatments and placing strong emphasis on the treatment of active disease.

Concluding his talk, Prof D’Cruz said, while challenges remain, the future for SLE treatment is bright, with over 90 investigative agents for the disease currently in development.

Author Bios

Credit: iStock.com/Andrzej Rostek

ADVERTISEMENT

Latest

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT