Overview
Clinical Meaning
Systemic lupus erythematosus (SLE) management at the NP level requires comprehensive understanding of disease pathogenesis, classification criteria, organ specific monitoring, a...
Systemic lupus erythematosus (SLE) management at the NP level requires comprehensive understanding of disease pathogenesis, classification criteria, organ-specific monitoring, and immunosuppressive pharmacotherapy. The 2019 EULAR/ACR classification criteria use a weighted scoring system (entry criterion: ANA ≥1:80) with additive criteria in seven clinical domains (constitutional, hematologic, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, renal) and three immunologic domains (antiphospholipid antibodies, complement levels, specific antibodies). A score ≥10 classifies as SLE. Disease activity is monitored using validated instruments: SLEDAI-2K (SLE Disease Activity Index — scores clinical and laboratory parameters), BILAG (British Isles Lupus Assessment Group — organ-specific activity), and physician global assessment. Lupus nephritis is the most serious common organ manifestation, occurring in 50% of patients. It is classified by ISN/RPS system on renal biopsy: Class I (minimal mesangial), Class II (mesangial proliferative), Class III (focal proliferative — affects <50% of glomeruli), Class IV (diffuse proliferative — most severe, affects ≥50% of glomeruli), Class V (membranous), and Class VI (advanced sclerosis). Treatment of Class III/IV nephritis follows a two-phase approach: induction (mycophenolate mofetil or IV cyclophosphamide for 6 months) followed by maintenance (mycophenolate or azathioprine...