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, including regular assessment of disease activity, medication side effects, and organ involvement, as recommended by the European League Against Rheumatism 1.

Key Monitoring Parameters

• Disease activity should be evaluated using a validated index at each visit, with organ damage assessed annually 1.
• General quality of life should be assessed by patient history and/or a 0–10 VAS (patient global score) at each visit 1.
• Comorbidities, such as cardiovascular risk factors, osteoporosis, and cancer, should be regularly assessed and managed 1.
• Drug toxicity, including the effects of immunosuppressants and corticosteroids, should be closely monitored 1.

Laboratory Tests

• Autoantibodies, including ANA, anti-dsDNA, anti-Ro, anti-La, anti-RNP, anti-Sm, and anti-phospholipid, should be monitored at baseline and as clinically indicated 1.
• Complement levels (C3, C4) should be checked regularly to assess disease activity and response to treatment 1.

Organ-Specific Monitoring

• Kidney function should be closely monitored, with regular urinalysis, protein/creatinine ratio, and estimated glomerular filtration rate to detect lupus nephritis early 1.
• Cardiovascular risk assessment is essential, with monitoring of blood pressure, lipid profiles, and glucose levels 1.
• Neuropsychiatric symptoms, skin manifestations, joint pain, and fatigue should be assessed at each visit 1.

Preventative Measures

• Regular bone density scans are recommended for patients on long-term steroids 1.
• Appropriate vaccinations should be maintained, considering the patient's immunosuppressed status 1.

Frequency of Assessments

• Patients with no activity, no damage, and no comorbidity can be assessed every 6–12 months, with more frequent assessments during flares or when changing treatment 1.

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
• 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
• Clinical signs and symptoms, such as:
  • Constitutional symptoms (arthralgia, weakness, fever) 2
  • Skin lesions 2
  • Neurological symptoms (paresthesia, polyneuropathy) 2
• Organ damage and treatment-related comorbidities, including:
  • Infections 5
  • Atherosclerosis 5
  • Retinal toxicity in patients taking hydroxychloroquine 6

Treatment-Related Monitoring

Patients with SLE should also be monitored for treatment-related side effects, such as:

• Glucocorticoid use and potential side effects 5, 6
• Immununosuppressive therapy and potential side effects 2, 4, 5
• Hydroxychloroquine use and potential side effects, including retinal toxicity 6

Disease Management

The goal of monitoring SLE is to:

• Control disease activity and prevent flares 4, 5
• Prevent organ damage and treatment-related comorbidities 4, 5
• Optimize health-related quality of life 5
• Achieve long-term patient survival 5