THERAPY.

Treatment must be individualized for each patient. Not all patients require steroids; steroids have the potential of doing more harm than good. The goals for each therapy and the potential of each for benefit and risk should be considered carefully. The goal is to maintain organ function and prevent permanent organ injury. The threat of a chronic disease can be very stressful, as can visiting a physician frequently and having many laboratory tests--and waiting for the results. Thus emotional support is essential, as well as counseling and the provision of written (and other) material. Patients should be assured that SLE is mild in most patients, that it is rarely life threatening, and that serious organ involvement can usually be prevented. Support by family, friends, and organizations such as the Lupus Foundation of America and the Arthritis Foundation is often helpful.

It is important to determine whether the symptoms and signs are due to SLE or something else(Table 289-10). For instance, fever is more likely to be due to an infection and fatigue due to lack of sleep. Low complement levels, high anti-DNA levels, and/or high immune complex levels suggest active SLE.

Preventive measures are useful. Patients should avoid using sulfonamides, penicillin, and high-estrogen birth control pills, which may exacerbate the lupus. Exercise has been demonstrated to ameliorate the fatigue associated with SLE. Patients should be questioned regarding their degree of photosensitivity; not all patients have photosensitivity, and the degree may vary, including variation over time. Photosensitive patients should use sunscreens daily with an SPF of at least 15; for those who are very photosensitive, sunscreen should be used twice daily.