【正文】 physician or evidence of pleural effusion) OR b. Pericarditis (documented by ECG, rub, or evidence of pericardial effusion) 7. Renal : a. Persistent proteinuria ( g/d or 3+) disorder OR b. Cellular casts of any type 8. Neurologic: a. Seizures (in the absence of other causes) disorder OR b. Psychosis (in the absence of other causes) 9. Hematologic: a. Hemolytic anemia disorder OR b. Leukopenia (4,000/mL on two or more occasions) OR c. Lymphopenia (l,500/mL on two or more occasions) OR d. Thrombocytopenia (100,000/mL in the absence of offending drugs) 10. Immunologic disorder: a. Antidoublestranded DNA OR b. AntiSm OR c. Positive finding of antiphospholipid antibodies based on (1) an abnormal serum level of IgG or IgM anticardiolipin antibodies, or (2) a positive test result for lupus anticoagulant using a standard method, or (3) a falsepositive serologic test for syphilis known to be positive for at least 6 months and confirmed by Treponema palliclum immobilization or fluorescent treponemal antibody absorption test 11. Antinuclear antibody: An abnormal titer of antinuclear antibody (ANA) by immunofluorescence or an equivalent assay at any time and in the absence of drugs known to be associated with druginduced lupus syndrome. For identifying patients in clinical studies, a person shall be said to have SLE if any four or more of the 11 criteria are present, either serially or simultaneously, during any interval or observation. This criteria holds a sensitivity of 85% and a specificity of 95%. TREATMENT Medical Care: Care of patients with systemic lupus erythematosus (SLE) depends on individual patient39。 sensitivity 95%。s manifestations and disease severity. ? Diet: No dietbased treatment of SLE has been proven effective. ? Activity: Patients should be reminded that activity may need to be modified as tolerated. ? stress such as physical illness may precipitate SLE flares. ? persons with SLE should wear sunscreen and protective clothing or avoid sun exposure to limit photosensitive rash or disease flares. ? Fever, skin, musculoskeletal, and serositis represent milder disease manifestations. These are often controlled with lowpotency medications, such as hydroxychloroquine and NSAIDS. Lowtomoderate–dose steroids and methotrexate are necessary for acute flares. Medication ? CNS involvement and renal disease must be recognized as more severe disease manifestations require highdose steroids and other immunosuppression agents such as cyclophosphamide, azathioprine, or mycophenolate. Traditionally, class IV diffuse proliferative lupus nephritis has been treated with aggressive cyclophosphamide induction therapy. Newer lupus nephritis literature has shown that mycophenolate is a safe maintenance agent and is potentially an induction agent. ? Acute emergencies in SLE include severe neurologic involvement, systemic vasculitis, profound thrombocytopenia with a TTPlike syndrome, rapidly progressive glomerulonephritis, or diffuse alveolar hemorrhage. ? Rare serious manifestations such as TTP, diffuse alveolar hemorrhage, or profound steroidrefractory thrombocytopenia may require large dosage of intravenous Methylprednisolone, plasma exchange or intravenous immunoglobulin (IVIG) ? New investigations are in progress to look at the role of rituximab and other Bcell–targeted therapies in SLE. ? Preventative care measures are necessary to minimize the risks of steroidinduced osteoporosis and accelerated atherosclerotic disease. – The ACR Guidelines for the prevention of glucocorticoidinduced osteoporosis suggest traditional steps and the consideration of prophylactic bisphosphonate therapy. – Recently, numerous authors have also advocated drafting cardiovascular prevention guidelines that equate SLE as a CAD riskequivalent similar to diabetes mellitus. Drug Category ? Nonsteroidal antiinflammatory drugs (NSAIDs) These agents provide symptomatic relief for arthralgias, fever, and mild serositis. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis NSAIDs may cause elevated liver function test results in patients with active SLE. Additionally, conitant administration with prednisone may increase risk of GI ulceration. Ibuprofen (Advil, Motrin, Ibuprin) for patients with mildtomoderate pain. ? Antimalarials The mechanism of action of antimalarials in SLE is unknown, but they do not cause generalized immunosuppression. They are useful to prevent and treat lupus skin rashes, constitutional symptoms, arthralgias, and arthritis. They also help to prevent lupus flares and have been associated with reduced morbidity and mortality in SLE. Hydroxychloroquine (Plaquenil) Inhibits chemotaxis of eosinophils and lootion of neutrophils and impairs plementdependent antigenantibody reactions. Hydroxychloroquine sulfate 200 mg is equivalent to 155 mg hydroxychloroquine base and 250 mg chloroquine phosphate. 200 mg PO qd/bid。 this and hypoplementemia may predispose persons with SLE ? Thrombocytopenia may be mild or part of a thrombotic thrombocytopenic purpura (TTP)–like syndrome. ? Anemia is occasionally overlooked in young menstruating women. Other ? History of recurrent early miscarriages or