What to monitor in a patient with Systemic Lupus Erythematosus (SLE)?

From the Guidelines

Monitoring patients with Systemic Lupus Erythematosus (SLE) requires a comprehensive approach that includes regular assessment of disease activity, organ involvement, medication effects, and complications, with the goal of achieving remission or low disease activity and preventing damage accrual and drug side-effects, as recommended by the 2019 update of the EULAR recommendations for the management of SLE 1.

Key Components of Monitoring

• Regular clinical evaluations every 3-6 months when stable, with more frequent visits during flares
• Laboratory monitoring, including:
  • Complete blood count
  • Comprehensive metabolic panel
  • Urinalysis
  • Complement levels (C3, C4)
  • Anti-dsDNA antibodies
  • Inflammatory markers like ESR and CRP
• Specific organ systems require targeted monitoring, such as:
  • Renal involvement: urinalysis, protein/creatinine ratio, and renal function tests
  • Cardiovascular risk: blood pressure, lipid profile, and glucose levels
  • Neuropsychiatric manifestations: cognitive function and mood changes
  • Musculoskeletal involvement: joint pain and function

Medication Monitoring

• Hydroxychloroquine: baseline and annual eye exams, with a daily dose not exceeding 5 mg/kg real body weight 1
• Immunossuppressants: regular blood counts and liver function tests
• Corticosteroids: monitoring for metabolic effects, bone density, and blood pressure

Infection Risk and Comorbidities

• Assessment of infection risk, especially when on immunosuppressants
• Appropriate vaccinations
• Regular screening for comorbidities like osteoporosis and cardiovascular disease

Frequency of Assessments

• Patients with no activity, no damage, and no comorbidity: assessments every 6-12 months 1
• More frequent visits during flares or when changing treatment By following this comprehensive monitoring approach, healthcare providers can help detect disease flares early, prevent organ damage, and minimize treatment complications, ultimately improving the quality of life for patients with SLE.

From the Research

Monitoring Systemic Lupus Erythematosus (SLE)

To monitor a patient with SLE, the following aspects should be considered:

• Disease activity indices, such as the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI score) 2, 3
• Cumulative history summary to track complicated patients over time 3
• Laboratory parameters, including:
  • Erythrocyte sedimentation rate 2
  • Anti-double-strand DNA antibodies 2
  • Complement levels (C3 and C4) 2
  • Proteinuria in patients with renal involvement 2, 4
• Organ damage and treatment toxicity 3
• Response to treatment, including changes in clinical signs and symptoms 2, 4

Treatment and Management

The treatment and management of SLE may involve:

• Medications, such as:
  • Rituximab 2
  • Cyclophosphamide 2, 4
  • Methylprednisolone 2
  • Hydroxychloroquine 5
• Monitoring for potential side effects and toxicity, such as retinal toxicity with hydroxychloroquine 5
• Regular follow-up and adjustment of treatment as needed to achieve and maintain remission 2, 4