Topic: Systemic Lupus Erythematosus: Early Diagnosis and Management Strategies

Systemic Lupus Erythematosus (SLE) is a complex, chronic autoimmune disease that affects multiple organs and systems throughout the body, including the skin, joints, heart, kidneys, serous membranes, nerves, blood vessels, etc. The wide range of clinical manifestations associated with SLE makes its diagnosis, management, and treatment particularly challenging. The 2019 EULAR/ACR SLE classification criteria for SLE are commonly used for diagnosis, requiring a combination of clinical and immunological factors, with an entry criterion of antinuclear antibodies at a titer of ≥1:80 to confirm autoimmune involvement, and a score of 10 or more points is necessary for diagnosis. Early diagnosis and timely initiation of treatment are crucial, as delaying intervention until severe organ involvement occurs can significantly worsen outcomes. The 10-year survival rate for SLE is 70-90%, a concerning statistic considering the typical age of onset, which ranges from the 20s to the 40s. Infection remains the leading cause of death among SLE patients. For more than half a century, non-specific glucocorticoids have been the cornerstone of SLE treatment, but are associated with serious side effects, including infection, and are the biggest determinant of prognosis. In recent years, however, the development of effective immunosuppressive drugs and biological agents has changed the treatment strategy. EULAR’s 2023 Recommendations for the Management of SLE advocate for the use of glucocorticoids as a bridging therapy during periods of high disease activity, with the aim of achieving and maintaining remission, mainly with antimalarials, biologics, and immunosuppressive drugs – except in cases of active renal impairment. Nonetheless, the therapeutic efficacy of existing drugs is insufficient in some cases, prompting the rapid development of new biologics, kinase inhibitors, and other small-molecule compounds. Furthermore, adoptive T cell transfer therapy - engineered to target the CD19 antigen via chimeric antigen receptors (CAR-T therapy) - has been applied to refractory SLE. This therapy works by rapidly and sustainably reducing circulating B cells, thereby resetting the immune system through the reorganization of autoreactive B cells and inducing sustained clinical remission. This Special Issue aims to highlight the latest advancements in understanding the pathogenesis of SLE, innovative therapeutic approaches, and the development of personalized medicine for managing this multifaceted disease. Through this collection, we hope to contribute to the ongoing efforts to improve patient outcomes and quality of life for those affected by SLE. We anticipate that the emerging trends in SLE treatment presented here will inspire and motivate young clinicians and researchers.

SLE, diagnosis, management, treatment, recommendations, biologics, immunosuppressants

31 Dec 2024