【正文】 if BW 130 lb, may be candidate for dose reduction to qd to minimize retinal toxicity ? Immunosuppressant agents These agents act as immunosuppressives and cytotoxic and antiinflammatory agents. Methotrexate (Folex PFS, Rheumatrex) For managing arthritis, serositis, cutaneous, and constitutional symptoms. Blocks purine synthesis and AICAR, thus increasing antiinflammatory adenosine concentration at sites of inflammation. Ameliorates symptoms of inflammation. mg PO/IM qwk Cyclophosphamide (Cytoxan) Used for immunosuppression in cases of serious SLE an involvement, especially severe CNS involvement, vasculitis, and lupus nephritis. As an alkylating agent, the mechanism of action of the active metabolites may involve crosslinking of DNA, which may interfere with growth of normal and neoplastic cells. 500750 mg/m2 IV qmo Azathioprine (Imuran) Immunosuppressant and less toxic alternative to cyclophosphamide and as steroidsparing agent in nonrenal disease. Antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. May decrease proliferation of immune cells, which results in lower autoimmune activity. 1 mg/kg/d PO for 68 wk, increase by mg/kg q4wk until response or until dose reaches mg/kg/d Immune globulin intravenous (Gamimune, Gammagard, Sandoglobulin) Used for immunosuppression in serious SLE flares. Neutralizes circulating myelin antibodies through antiidiotypic antibodies. Downregulates proinflammatory cytokines, including INFgamma. Blocks Fc receptors on macrophages, suppresses inducer T and B cells, and augments suppressor T cells. Blocks plement cascade, promotes remyelination, and may increase CSF IgG (10%). 2 g/kg IV over 25 d Mycophenolate (CellCept) Useful for maintenance in lupus nephritis and other serious lupus cases. Inhibits inosine monophosphate dehydrogenase (IMPDH) and suppresses de novo purine synthesis by lymphocytes, thereby inhibiting their proliferation. Inhibits antibody production. 1 g PO bid Corticosteroids These agents are used predominately for antiinflammatory activity and as immunosuppressants. Preparations include oral, intravenous, topical, and intraarticular injections. Methylprednisolone (Adlone, Medrol, SoluMedrol, Depopred) Used for acute anthreatening exacerbations. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. 1 g/d IV for 3 d Prednisone (Deltasone, Orasone, Meticorten) Immunosuppressant for treatment of autoimmune disorders. May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and suppresses lymphocytes and antibody production. Lowdose oral prednisone can be used for milder SLE, but more severe involvement necessitates high doses of oral or intravenous therapy 5mg/d to 1mg/kg/d PO qd or divided bid/qid。 atrophic scarring may occur in older lesions 3. Photosensitivity: Skin rash as an unusual reaction to sunlight, by patient history or physician observation 4. Oral ulcers: Oral or nasopharyngeal ulcers, usually painless, observed by physician 5. Arthritis: Nonerosive arthritis involving two or more peripheral joints, characterized by tenderness, swelling, or effusion 6. Serositis: a. Pleuritis (convincing history of pleuritic pain or rub heard by 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。 CRP levels change more acutely, and ESR lags behind disease changes. – Complement levels: C3 and C4 levels are often