From the Guidelines
When evaluating a patient with systemic lupus erythematosus (SLE) during an initial visit, it is crucial to assess disease activity by a validated index, organ damage annually, general quality of life, comorbidities, and drug toxicity, as recommended by the European League Against Rheumatism 1. This comprehensive assessment is essential for understanding the patient's condition and guiding treatment decisions.
Key Components of Initial Visit Assessment
- Disease activity assessment using a validated index at each visit
- Organ damage evaluation annually
- General quality of life assessment by patient history and/or a 0–10 VAS (patient global score) at each visit
- Comorbidities assessment, including cardiovascular risk factors, osteoporosis, and cancer screening
- Drug toxicity evaluation, particularly for patients on immunosuppressive drugs
Additional Recommendations
- Screen for cardiovascular risk factors, including smoking, vascular events, physical activity, oral contraceptives, hormonal therapies, and family history of cardiovascular disease, at baseline and during follow-up at least once a year 1
- Assess osteoporosis risk and screen according to existing guidelines, especially for postmenopausal women and patients on steroids 1
- Evaluate infection risk, including screening for HIV, HCV, HBV, and tuberculosis, and administer inactivated vaccines, such as flu and pneumococcus, according to CDC guidelines for immunosuppressed patients 1
Laboratory Assessment
- Monitor autoantibodies and complement levels, including ANA, anti-dsDNA, anti-Ro, anti-La, anti-RNP, anti-Sm, anti-phospholipid, C3, and C4, at baseline and re-evaluate in previously negative patients as necessary 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
SLE Initial Visit Questions
When a patient with Systemic Lupus Erythematosus (SLE) visits for the first time, several key points should be considered:
- The patient's symptoms and medical history should be thoroughly reviewed to determine the severity of their condition and the best course of treatment 2, 3.
- The use of hydroxychloroquine has been shown to be effective in delaying the onset of SLE and reducing the risk of flares 2, 4, 5.
- Patients with SLE are at risk for various comorbidities, including coronary artery disease, osteoporosis, and infections, which should be taken into account when developing a treatment plan 6, 4.
- The patient's lifestyle and environmental factors, such as exposure to ultraviolet light, should also be considered and addressed as part of their treatment plan 6.
Key Considerations for SLE Patients
Some key considerations for SLE patients include:
- The importance of early recognition and management of SLE-related conditions and comorbidities 3.
- The use of immunomodulators and immunosuppressants, such as hydroxychloroquine and azathioprine, to manage symptoms and prevent flares 2, 4, 5.
- The need for regular monitoring and follow-up to adjust treatment plans as needed and prevent complications 3, 6.
- The importance of patient education and lifestyle modifications, such as avoiding ultraviolet light and maintaining a healthy diet, to manage symptoms and prevent flares 6.