An experienced US-based medical billing outsourcing company, Outsource Strategies International (OSI) provides medical billing and coding services for individual physicians, medical practices, clinics, and hospitals.

In today’s podcast, Meghann Drella, one of our Senior Solutions Managers, discusses the challenges associated with the diagnosis and clinical management of Systemic Lupus Erythematosus.

Hello and welcome to our podcast series. My name Is Meghann Drella and I am a senior solutions manager here at Outsource Strategies International. Today, I will be discussing Systemic Lupus Erythematosus – Addressing Challenges of Diagnosis and Clinical Management.

00:17 – Systemic lupus erythematosus – Introduction

Systemic lupus erythematosus, now referred to as SLE, moving forward in this podcast, or lupus is an autoimmune rheumatic disorder in which the immune system mistakenly attacks healthy cells in the body, causing pain and severe tissue damage involving multiple organ systems. Lupus can affect the joints, skin, lungs, kidneys, nervous system, blood vessels and many other organs. SLE is a chronic disease that is often characterized by flares or worsening of symptoms followed by periods where symptoms decrease.

00:50 – Types of Lupus

There are four types of lupus

  • Systemic lupus erythematosus (SLE), which is the most common type
  • Cutaneous lupus, which is a type that causes skin disease
  • Drug-induced lupus, which is a disease caused by certain prescription drugs, and
  • Neonatal lupus, a rare disorder that affects infants whose mothers have lupus

According to the Lupus Foundation of America, about 1.5 million Americans have some form of lupus and about 70 percent have SLE. While anyone can develop lupus, certain people are at higher risk for the disease such as women of child-bearing age, and people who have a family member who has lupus or another autoimmune disease. Some individuals are born with a tendency towards developing this condition, which may be triggered by infections, stress, certain drugs, or even sunlight. While there is no permanent cure for SLE, correct and timely treatment can help relieve symptoms, reduce inflammation, and minimize organ damage.

01:47 - Signs and Symptoms of SLE

Lupus can cause different symptoms depending on the part or parts of the body it affects. The most distinctive sign of SLE is a facial rash that resembles the wings of a butterfly unfolding across both cheeks that occurs in many but not all cases of this disease. Common signs and symptoms of lupus include

  • Severe fatigue
  • Headache
  • Joint pain
  • Swelling in the hands, feet, or around the eyes
  • Skin lesions that appear or worsen with sun exposure
  • Sensitivity to light
  • Hair loss
  • Anemia
  • Blood-clotting problems
  • Chest pain when taking deep breaths
  • Dry eyes
  • Discoloration of the fingers when exposed to changes in temperature or during stressful periods

The symptoms of SLE may be mild or severe and may occur suddenly or develop slowly. Many symptoms of lupus are similar to those of other diseases such as arthritis, fibromyalgia, and diabetes. All of these factors make it very difficult to diagnose lupus.

02.45 - Diagnosing SLE

 Patients with suspected SLE should be referred to a rheumatologist to confirm diagnosis and ensure ongoing care. The rheumatologist will conduct a detailed clinical history and examination to identify the relevant signs and symptoms of SLE. Standard diagnostic tests used include:

  • A CBC with differential
  • Serum creatinine
  • Urinalysis
  • ESR or CRP level
  • Complement levels
  • Liver function tests
  • Creatine kinase assay
  • Spot protein, and
  • Autoantibody tests

Imaging studies such as joint radiography, chest radiography and chest CT scanning, echocardiography, brain MRI/MRA, and cardiac MRI may also be used to confirm diagnosis.

However, like many autoimmune diseases, lupus is challenging to diagnose accurately as symptoms of lupus are also found in many other conditions.

03.39 – Treatment

 Due to the multi-systemic nature of the disease, healthcare providers from different specialties may be part of the lupus healthcare team, depending on the affected organ system. In addition to a rheumatologist, the team may include specialists in fields such as infectious disease, neurology, pulmonology, cardiology, gastroenterology, nephrology, dermatology, hematology, and obstetrics.

There is no complete cure for SLE, but treatment can help ease symptoms. Treatment modalities mainly include non-steroidal anti-inflammatory drugs (NSAIDs) for joint pain and stiffness, corticosteroids (to minimize the immune response), anti-malarial drugs (for skin and joint problems) and immune-suppressants. Treatment recommended will depend on the type and severity of symptoms and which parts of the body SLE has affected.

Treatments are most effective when you start them soon after symptoms develop. Prevention of lupus involves avoiding/reducing sun exposure, getting adequate sleep and taking the recommended medications.

04:37 - Improving Diagnosis and Care

 The Addressing Lupus Pillars for Health Advancement (ALPHA) global consensus initiative that validates known challenges in lupus is a major step towards implementing strategies to address the concerns around this complicated disease. This global council led project identified the 5 top barriers to improving outcomes in lupus as: clinical trials, biomarkers, diagnosis of lupus, differentiation of its subtypes, and outcome measures for the disease. The council calls for a concerted effort by lupus clinicians, researchers, policy makers and other stakeholders to improve understanding of the disease to guide development, diagnosis and treatment and also provide patients with access to timely, high-quality care.

I hope this helps, but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you so much for joining me, and stay tuned for my next podcast!