NONPHARMACOLOGIC MANAGEMENT
There is little, if any, literature on nonpharmacologic management of SLE. Despite the lack of evidence, EULAR and ACR guidelines do make some recommendations.24,25 All patients with SLE should practice proper sun protection as approximately one-third of patients are photosensitive. Patients should be instructed to avoid direct exposure to sunlight and use protective clothing and sunscreens that block both ultraviolet A (UVA) and UVB rays. Patients should also be counseled to avoid tanning beds. This is especially important for patients with cutaneous involvement. Smoking cessation is also recommended for all patients with SLE because current smokers have been shown to have significantly higher SLEDAI scores than previous smokers or never smokers.28
It is also important that patients maintain proper nutrition, including adequate intake of calcium and vitamin D.25 These are especially important in patients receiving long-term glucocorticoid therapy. Vitamin D levels should be monitored periodically as well, since patients are encouraged to avoid sun exposure, which could cause problems with inadequate conversion of vitamin D in the skin. In addition, it is recommended that patients exercise routinely. Patients may also need other individualized nonpharmacologic therapy based on the different comorbid conditions that may be present (such as diet and exercise recommendations for patients with cardiovascular disease).