Michelle A. Petri, MD, MPH, prepared useful Practice Aids pertaining to systemic lupus erythematosus for this CME activity titled "Improving the Diagnosis and Treatment of Lupus: Practical Guidance for the Primary Care Physician." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2IDqqpz. CME credit will be available until June 11, 2019.

1. Access the activity,“Improving the Diagnosis and Treatment of Lupus: Practical
Guidance for the Primary Care Physician,”at www.peerview.com/FYE40.
Information for Patients:
Lupus Medications and
Treatment Options1
PRACTICE AID
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
DHEA: dehydroepiandrosterone; NSAID: nonsteroidal anti-inflammatory drugs.
1. https://www.hopkinslupus.org/lupus-treatment/. Accessed May 11, 2018.
NSAIDs
• These anti-inflammatory medications relieve some lupus symptoms by reducing the inflammation
responsible for the stiffness and discomfort in your muscles, joints, and other tissues
• NSAIDs are milder than many other lupus drugs and may be taken either alone to treat a mild flare
or in combination with other medications
Antimalarial drugs
• Plaquenil (hydroxychloroquine) and other antimalarials are the key to controlling lupus long term,
and some lupus patients may be on Plaquenil for the rest of their lives; for this reason, you can
think of antimalarials as a sort of “lupus life insurance”
Steroids
• Synthetic cortisone medications are some of the most effective treatments for reducing the
swelling, warmth, pain, and tenderness associated with the inflammation of lupus; cortisone
usually works quickly to relieve these symptoms
• However, cortisone can also cause many unwelcome side effects, so it is usually prescribed only
when other medications—specifically NSAIDs and anti-malarials—are not sufficient enough to
control lupus
Immunosuppressive medications
• Immunosuppressives are medications that help suppress the immune system; many were
originally used in patients who received organ transplants to help prevent their bodies from
rejecting the transplanted organ
• However, these drugs (eg, methotrexate, azathioprine, belimumab) are now also used for the
treatment of certain autoimmune diseases, such as lupus and rheumatoid arthritis
DHEA
• DHEA is a mild male hormone that is effective in treating some of the symptoms of mild to
moderate lupus, including hair loss (alopecia), joint pain, fatigue, and cognitive dysfunction
(eg, difficulty thinking, memory loss, distractibility, difficulty in multitasking); DHEA can also be
effective against osteoporosis

2. Access the activity,“Improving the Diagnosis and Treatment of Lupus: Practical
Guidance for the Primary Care Physician,”at www.peerview.com/FYE40.
Systemic Lupus International
Collaborating Clinics (SLICC)
Classification Criteria for Systemic
Lupus Erythematosus1
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
ANA: antinuclear antibody; C3: complement 3; C4: complement 4; CH50: total complement; dsDNA: double-stranded DNA; ELISA: enzyme-linked immunosorbent assay; IgA: immunoglobulin A;
IgG: immunoglobulin G; IgM: immunoglobulin M; RPR: rapid plasma regain; SLE: systemic lupus erythematosus; Sm: Smith antibody.
1. Petri M et al. Arthritis Rheum. 2012 ;64:2677-2686.
PRACTICE AID
Clinical Criteria
1. Acute/subacute cutaneous lupus
Lupus malar rash (do not count if malar discoid)
Bullous lupus
Toxic epidermal necrolysis variant of SLE
Maculopapular lupus rash
Photosensitive lupus rash (in the absence of dermatomyositis) OR subacute cutaneous lupus (nonindurated psoriaform and/or
annular polycyclic lesions that resolve without scarring, although occasionally with postinflammatory dyspigmentation or telangiectasias)
2. Chronic cutaneous lupus
Classic discoid rash (localized [above the neck] or generalized [above and below the neck]), hypertrophic (verrucous) lupus, lupus
panniculitis (profundus), mucosal lupus, lupus erythematosus tumidus, chilblains lupus, OR discoid lupus/lichen planus overlap
3. Oral ulcers (palate [buccal or tongue]) OR nasal ulcers (in the absence of other causes, such as vasculitis, Behçet's disease, infection
[herpesvirus], inflammatory bowel disease, reactive arthritis, and acidic foods)
4. Nonscarring alopecia
Diffuse thinning or hair fragility with visible broken hairs (in the absence of other causes, such as alopecia areata, drugs, iron deficiency, and
androgenic alopecia)
5. Synovitis involving 2 or more joints, characterized by swelling or effusion OR tenderness in 2 or more joints and
30 minutes or more of morning stiffness
6. Serositis
Typical pleurisy for more than 1 day, pleural effusions, or pleural rub, OR typical pericardial pain (pain with recumbency improved by sitting
forward) for more than 1 day, pericardial effusion, pericardial rub, OR pericarditis by electrocardiography (in the absence of other causes,
such as infection, uremia, and Dressler's syndrome)
7. Renal
Urine protein/creatinine (or 24-hour urine protein) representing at least 500 mg of protein/24 hours OR red blood cell casts
8. Neurologic: seizures, psychosis, mononeuritis multiplex, myelitis, peripheral or cranial neuropathy, cerebritis
(acute confusional state)
9. Hemolytic anemia
10. Leukopenia (<4,000/mm3
at least once) OR lymphopenia (<1,000/mm3
at least once)
11. Thrombocytopenia (<100,000/mm3
) at least once
Immunologic Criteria
1. ANA above laboratory reference range
2. Anti-dsDNA above laboratory reference range, except ELISA (twice above laboratory reference range)
3. Anti-Sm
4. Antiphospholipid antibody, determined by any of the following
Lupus anticoagulant
False-positive RPR
Medium- or high-titer anticardiolipin (IgA, IgG, or IgM)
Anti-β2-glycoprotein 1 (IgA, IgG, or IgM)
5. Low complement
Low C3
Low C4
Low CH50
6. Direct Coombs test (in the absence of hemolytic anemia)
Classify a patient as having SLE if
• The patient satisfies four of the criteria listed in the table above, including at least one clinical criterion and one
immunologic criterion
OR
• The patient has biopsy-proven nephritis compatible with SLE and with ANA or anti-dsDNA antibodies

3. Access the activity,“Improving the Diagnosis and Treatment of Lupus: Practical
Guidance for the Primary Care Physician,”at www.peerview.com/FYE40.
Information for Patients:
Common Medications for Other
Conditions in People With Lupus1
PRACTICE AID
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Aspirin
• Low doses of aspirin are often recommended for lupus patients who have antiphospholipid antibodies
and may reduce the risk of heart attack and stroke
Antidepressants
• Antidepressant medications are used to treat depression and anxiety, which is present in almost half of all
people who have lupus
• It is important that you speak with your doctor if you feel you are experiencing clinical depression,
because many people who are physically ill respond well to antidepressant medications; in addition,
your doctor may treat your depression in different ways depending on the cause
Antiplatelet medications (platelet antagonists)
• Some lupus patients are at an increased risk for blood clots because of the prevalence of a condition
known as antiphospholipid antibody syndrome (APS); platelet antagonists help prevent these clots and,
in doing so, also help to prevent heart attack, stroke, and other complications
Osteoporosis medications (bisphosphonates)
• Bisphosponates are medications used to treat and prevent osteoporosis; people with lupus are at an
increased risk for this condition because of the inflammation they experience with the disease
• Certain medications taken by lupus patients also increase the risk of osteoporosis, especially
corticosteroids such as prednisone
Blood pressure medications (antihypertensives)
• 25% to 30% of people with lupus experience hypertension (high blood pressure); the most common
causes of high blood pressure in people with lupus are kidney disease and long-term steroid use
• Other medications, such as cyclosporine (Neoral, Sandimmune, Gengraf) can also cause elevations in
blood pressure
• It is important to remember that while diet and exercise are extremely important for optimal cardiovascular
health, these elements alone may be insufficient in controlling your blood pressure; in this case, your doctor
will prescribe a medication
Anticoagulants
• Anticoagulants (“blood thinners”) are medications that decrease the ability of the blood to clot and are
used in lupus patients with antiphospholipid antibodies to reduce the risk of deep venous thrombosis
(DVT), stroke, and heart attack
Gastrointestinal medications
• Many people with lupus suffer from gastrointestinal problems, especially heartburn caused by
gastroesophageal reflux disease (GERD); peptic ulcers can also occur, often because of certain medications
used in lupus treatment, including NSAIDs and steroids
• Certain medications may be prescribed or recommended by your doctor to control these conditions

4. Access the activity,“Improving the Diagnosis and Treatment of Lupus: Practical
Guidance for the Primary Care Physician,”at www.peerview.com/FYE40.
Information for Patients:
Common Medications for Other
Conditions in People With Lupus1
PRACTICE AID
1. https://www.hopkinslupus.org/lupus-treatment/. Accessed May 11, 2018.
Cholesterol medications (statins)
• Statins are medications that lower the level of cholesterol in your blood by reducing the production
of cholesterol in the liver; people with high levels of cholesterol in their blood face an increased risk of
cardiovascular disease, which can lead to chest pain, heart attack, stroke, and peripheral vascular disease
• Studies have shown that people with lupus are more likely to have clogged arteries that can lead to heart
attack and stroke at a younger age; this increased risk is caused by elevated cholesterol levels, high blood
pressure, diabetes, and inflammation, conditions that occur often in people with lupus
• Certain medications, such as corticosteroids (eg, prednisone), can provoke or compound these symptoms;
for this reason, the cholesterol-lowering properties of statins are commonly called upon for lupus patients
Thyroid medications
• Autoimmune thyroid disease is common in lupus; it is believed that about 6% of people with lupus have
hypothyroidism (underactive thyroid) and about 2% have hyperthyroidism (overactive thyroid)
• A thyroid gland that is functioning improperly can affect the function of organs such as the brain, heart,
kidneys, liver, and skin
• Hypothyroidism can cause weight gain, fatigue, depression, moodiness, and dry hair and skin;
hyperthyroidism can cause weight loss, heart palpitations, tremors, and heat intolerance, and can
eventually lead to osteoporosis
• Treatment for both underactive and overactive thyroid involves getting your body’s metabolism back
to normal
Fibromyalgia medications
• Fibromyalgia is a chronic disorder characterized by widespread pain and tenderness, general fatigue,
and nonrestful sleep
• Many people with lupus have fibromyalgia; in fact, much of the pain that people with lupus feel is because
of this condition
• Three medications are used to reduce some of the physical and emotional symptoms of fibromyalgia
Restasis (dry eye medication)
• Restasis is an immunosuppressive medication used to treat eye symptoms related to Sjogren’s syndrome,
a chronic autoimmune disorder in which the glands that produce tears and saliva do not function correctly

5. Access the activity,“Improving the Diagnosis and Treatment of Lupus: Practical
Guidance for the Primary Care Physician,”at www.peerview.com/FYE40.
Information for Patients:
Lifestyle Information1
PRACTICE AID
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
1. https://www.hopkinslupus.org/lupus-info/lifestyle-additional-information/. Accessed May 11, 2018.
THINGS TO
AVOID
Sunlight
Echinacea
Bactrim and Septra
(sulfamethoxazole and
trimethoprim)
Alfalfa sprouts
Melatonin and
Rozerem (ramelteon)
Garlic