Should Generalized Immunosuppression or Targeted Organ Treatment be the Best Principle for Overall Management of Systemic Lupus Erythematosus?

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease, and standard therapy algorithms include the use of agents with generalized immunosuppressive effects. The outcomes for SLE patients have been markedly improved by this approach. However, the concept that involved organs might be targeted for treatment in an individual patient has potential to provide further benefits, offering enhanced efficacy and fewer off-target effects. This review considers how two of the most commonly involved organ systems in SLE, skin and kidney, might be targets for new therapeutic approaches based on knowledge of underlying mechanisms of disease.