The British Society for Rheumatology Guideline for the Management of Systemic Lupus Erythematosus in Adults

Caroline Gordon; Maame-Boatemaa Amissah-Arthur; Mary Gayed; Sue Brown; Ian N. Bruce; David D'Cruz; Benjamin Empson; Bridget Griffiths; David Jayne; Munther Khamashta; Liz Lightstone; Peter Norton; Yvonne Norton; Karen Schreiber; David Isenberg

Disclosures

Rheumatology. 2018;57(1):e1-e45. 

In This Article

Recommendations for Monitoring of SLE

  1. Patients with lupus should be monitored on a regular basis for disease manifestations, drug toxicity and co-morbidities (LOE 2 ++, GOR B, SOA 99%).

  2. Those with active disease should be reviewed at least every 1–3 months (2+, C/D), with blood pressure (1+/A), urinalysis (1+/A), renal function (1+/A), anti-dsDNA antibodies (2 ++/B), complement levels (2+/C), CRP (2+/C), full blood count (3/C), and liver function tests (4/D) forming part of the assessment, and further tests as necessary (4/D). Patients with stable low disease activity or in remission can be reviewed less frequently, for example, 6–12 monthly (4/D) (SOA 99%).

  3. The presence of aPLs is associated with thrombotic events, damage, and adverse outcomes in pregnancy (2 ++/B). If previously negative, they should be re-evaluated prior to pregnancy or surgery, or in the presence of a new severe manifestation or vascular event (4/D) (SOA 96%).

  4. Anti-Ro and anti-La antibodies are associated with neonatal lupus (including CHB) and should be checked prior to pregnancy (1+/A) (SOA 100%).

  5. Patients with lupus are at increased risk of co-morbidities, such as atherosclerotic disease, osteoporosis, avascular necrosis, malignancy and infection (2+/C). Management of modifiable risk factors, including hypertension, dyslipidaemia, diabetes, high BMI and smoking, should be reviewed at baseline and at least annually (4/D) (SOA 98%).

  6. Immunosuppressive therapy may lead to toxicities. Close monitoring of drugs by regular laboratory tests and clinical assessment should be performed in accordance with drug monitoring guidelines (4/D) (SOA 98%).

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