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SLICC damage index, renal biopsy guidance, and hydroxychloroquine-centred management
Systemic lupus erythematosus (SLE) is a prototypic systemic autoimmune disease characterised by loss of self-tolerance, autoantibody production, and immune complex-mediated inflammation affecting virtually every organ system. At Dr. Shree Narayan's clinic, SLE management follows a treat-to-target paradigm using the SLEDAI-2K activity index, organ-specific damage assessment via the SLICC/ACR Damage Index, and a hydroxychloroquine-centred regimen that reduces flares, thrombosis, and mortality across all disease subtypes. Lupus nephritis — the most significant predictor of poor long-term outcome — is managed with protocolised induction and maintenance immunosuppression guided by renal biopsy classification. Antiphospholipid antibody screening and thrombosis risk stratification are integrated into routine follow-up.
Kathmandu Neurology Clinic & Cognitive Center
Authored and reviewed by Dr. Shree Narayan Yadav (MBBS (KU), MD-Internal Medicine (NAMS), MSc Clinical Rheumatology (USW, UK), NMC 14227). Evidence-based, no fabricated outcomes.
Systemic lupus erythematosus (SLE) is a prototypic systemic autoimmune disease characterised by loss of self-tolerance, autoantibody production, and immune complex-mediated inflammation affecting virtually every organ system. At Dr. Shree Narayan's clinic, SLE management follows a treat-to-target paradigm using the SLEDAI-2K activity index, organ-specific damage assessment via the SLICC/ACR Damage Index, and a hydroxychloroquine-centred regimen that reduces flares, thrombosis, and mortality across all disease subtypes. Lupus nephritis — the most significant predictor of poor long-term outcome — is managed with protocolised induction and maintenance immunosuppression guided by renal biopsy classification. Antiphospholipid antibody screening and thrombosis risk stratification are integrated into routine follow-up.
Reviewed by Dr. Shree Narayan Yadav, MBBS, MD, MSc — Consultant Physician & Joint and Autoimmune Disease Specialist (NMC 14227), Kathmandu Neurology Clinic. For evaluation, book an appointment.
SLE can affect the skin (malar rash, discoid lesions, photosensitivity), joints (non-erosive polyarthritis), kidneys (lupus nephritis Class I-VI), blood (haemolytic anaemia, leucopenia, thrombocytopenia), serous membranes (pleuritis, pericarditis), and nervous system (seizures, psychosis, cognitive dysfunction). The EULAR/ACR 2019 classification criteria require an ANA titre of 1:80 or greater as an entry criterion, followed by weighted scoring across clinical and immunological domains. Activity is quantified using SLEDAI-2K, and accumulated irreversible damage is tracked with the SLICC Damage Index assessed annually.
Hydroxychloroquine (HCQ) is the cornerstone of SLE management, recommended for all patients unless contraindicated. It reduces flare rates by 50%, prevents accrual of organ damage, improves lipid profiles, reduces thrombotic risk, and improves pregnancy outcomes. The standard dose is 200 to 400 mg daily (capped at 5 mg/kg actual body weight). Ophthalmological screening is mandatory: baseline within the first year, then annually after 5 years of use, or sooner in the presence of renal impairment, tamoxifen use, or pre-existing macular disease.
Guidelines referenced:
Lupus nephritis occurs in approximately 50% of SLE patients and is the strongest predictor of end-stage renal disease. Renal biopsy is essential for classification (ISN/RPS Classes I-VI) and guides treatment. Proliferative nephritis (Class III and IV) requires aggressive induction with mycophenolate mofetil or intravenous cyclophosphamide followed by long-term maintenance with mycophenolate mofetil. Belimumab has been approved as add-on therapy for active lupus nephritis, and voclosporin represents a newer calcineurin inhibitor option with dual antiproteinuric and immunosuppressive effects.
Fanouriakis A et al. 2019 update of the EULAR recommendations for SLE management. Ann Rheum DisKDIGO 2021 clinical practice guideline for the management of glomerular diseases (lupus nephritis section)Aringer M et al. EULAR points to consider for the management of SLE. Ann Rheum Dis 2023Content on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.