From the Guidelines
For a patient with SALE, monitoring should focus on disease activity, organ involvement, and medication side effects, with regular assessments every 3-6 months, as suggested by the most recent guidelines 1.
Monitoring Approach
The monitoring approach for a patient with SALE should include:
- Regular assessment of skin manifestations, including evaluation of rash distribution, severity, and response to treatment
- Laboratory monitoring, including:
- Complete blood count
- Comprehensive metabolic panel
- Urinalysis
- Complement levels (C3, C4)
- Anti-Ro/SSA and anti-La/SSB antibody levels every 3-6 months
- Renal function monitoring through urinalysis, protein/creatinine ratio, and serum creatinine to detect early nephritis
- Cardiovascular risk assessment, as these patients have an increased risk of atherosclerosis
- For patients on hydroxychloroquine, baseline and annual eye examinations are necessary to detect retinal toxicity
- For those on immunosuppressants like methotrexate or mycophenolate mofetil, regular liver function tests and blood counts are required
- Sun protection adherence should be assessed at each visit, as UV exposure can trigger flares
- Quality of life measures and screening for depression are also important components of comprehensive care
Frequency of Monitoring
The frequency of monitoring for a patient with SALE may vary depending on the individual patient's needs and disease activity. However, as a general guideline, monitoring every 3-6 months is suggested, with more frequent monitoring needed early in the course of disease and in patients with active or progressive disease 1.
Importance of Collaboration
Collaboration between rheumatologists and pulmonologists is essential for the comprehensive care of patients with SALE, as it allows for shared decision-making and tailored monitoring approaches 1.
From the Research
Monitoring Parameters for a Patient with Salt Imbalance (Hypernatremia or Hyponatremia)
- Electrolyte levels: Monitor sodium levels regularly to assess the severity of the imbalance and the effectiveness of treatment 2, 3, 4.
- Kidney function: Assess glomerular filtration rate (GFR) to evaluate kidney function, as electrolyte imbalances can affect kidney function 2, 4.
- Fluid status: Monitor fluid intake and output to assess the patient's hydration status and adjust treatment accordingly.
- Liver function: Evaluate liver function tests, such as ALT, AST, and alkaline phosphatase, to assess for any underlying liver disease that may be contributing to the electrolyte imbalance 5.
- Blood urea nitrogen (BUN) and creatinine levels: Monitor BUN and creatinine levels to assess for any kidney damage or disease that may be contributing to the electrolyte imbalance 3, 4.
Laboratory Tests
- Serum electrolyte panel: Monitor sodium, potassium, chloride, and bicarbonate levels to assess the severity of the electrolyte imbalance.
- Urine electrolyte panel: Monitor urine sodium, potassium, and chloride levels to assess the patient's renal response to treatment.
- GFR estimation: Use equations based on serum creatinine levels to estimate GFR and assess kidney function 2.
- Liver function tests: Monitor ALT, AST, and alkaline phosphatase levels to assess for any underlying liver disease 5.