How to manage lupus in primary care

Although effective management of complex conditions like lupus usually requires a multidisciplinary approach, primary care doctors play a crucial frontline role in coordinating care and providing essential interventions for patients presenting with this condition.

In this article, we will explore the key aspects of managing lupus in a primary care setting.

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in General Dermatology.

What is lupus?

Lupus is a heterogeneous disease characterised by autoantibody production, inflammation, and tissue damage. Its clinical manifestations range from mild skin involvement to severe systemic complications affecting organs such as the kidneys, heart, and lungs.

From the general dermatology point of view, the dermatological manifestations of the condition are the most significant. These include:

• Cutaneous lupus erythematosus (CLE),
• Discoid lupus erythematosus (DLE),
• Subacute cutaneous lupus erythematosus (SCLE), and
• Acute cutaneous lupus erythematosus (ACLE).

Recognising these dermatological presentations is essential for early diagnosis and intervention.

What are the key management strategies for lupus?

Here’s an overview of vital steps primary care doctors can take as a part of an effective lupus management strategy:

Diagnosis and assessment of lupus

• The first step is to obtain a thorough medical history and perform a comprehensive physical examination. It is vital to pay particular attention to cutaneous manifestations.
• Secondly, a GP should order appropriate laboratory tests, including antinuclear antibody (ANA), anti-double-stranded DNA (anti-dsDNA), and complement levels. These will aid in diagnosis and assess disease activity.
• If necessary, consider referral to a rheumatologist for confirmation of diagnosis and specialised management, especially in cases of systemic involvement.

Treatment of cutaneous manifestations

• Topical corticosteroids are the mainstay of therapy for localised skin lesions in CLE, such as DLE and ACLE.
• For more widespread or refractory disease, systemic therapies such as antimalarials (e.g., Hydroxychloroquine) and immunosuppressive agents (e.g., methotrexate, mycophenolate mofetil) may be necessary.
• It is also important to educate patients on sun protection measures, as UV exposure can often exacerbate cutaneous lupus lesions.

Lupus monitoring and follow-up

• A primary care physician should always schedule regular follow-up appointments to monitor disease activity, treatment response, and medication side effects.

• GPs should maintain a collaboration with rheumatologists and other specialists to manage systemic manifestations and address comorbidities, such as renal or cardiovascular involvement.

Patient education and support

• It is essential to provide patients with comprehensive education about lupus at a primary care level. This includes potential complications related to the condition, the importance of medication adherence, and lifestyle modifications.
• Doctors may also offer emotional support and refer patients to support groups or counselling services to help them cope with the challenges of living with a chronic illness.

Managing lupus in a primary care setting requires additional education and a comprehensive approach, encompassing early recognition, prompt diagnosis, and coordinated multidisciplinary care. By understanding the diverse manifestations of lupus, doctors can play a pivotal role in improving patient outcomes and enhancing their quality of life.

– Dr Rosmy De Barros

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in General Dermatology.

Engaging with this blog can help meet your annual  Education Activities CPD requirement!

How to claim your CPD hours If you consume educational webinars, podcasts, articles, or research on this blog, you can Quick Log CPD hours with the RACGP via the usual self-submission process. You will be asked to reflect on what you have learned, and you will require supporting evidence such as a screenshot. Download the RACGP’s guide to self-recording your CPD here.

Read another article like this one: How to manage urticaria (hives)

References:

1. Ameer MA, Chaudhry H, Mushtaq J, et al. An Overview of Systemic Lupus Erythematosus (SLE) Pathogenesis, Classification, and Management. Cureus. 2022;14(10):e30330. Published 2022 Oct 15. doi:10.7759/cureus.30330
2. Stull C, Sprow G, Werth VP. Cutaneous Involvement in Systemic Lupus Erythematosus: A Review for the Rheumatologist. J Rheumatol. 2023;50(1):27-35. doi:10.3899/jrheum.220089
3. Yu H, Nagafuchi Y, Fujio K. Clinical and Immunological Biomarkers for Systemic Lupus Erythematosus. Biomolecules. 2021;11(7):928. Published 2021 Jun 22. doi:10.3390/biom11070928
4. Hannon CW, McCourt C, Lima HC, Chen S, Bennett C. Interventions for cutaneous disease in systemic lupus erythematosus. Cochrane Database Syst Rev. 2021;3(3):CD007478. Published 2021 Mar 9. doi:10.1002/14651858.CD007478.pub2