Key Questions Your Attending May Ask When Presenting an SLE Case
Your attending will likely focus on questions that assess disease activity, organ involvement, and management strategies to minimize morbidity and mortality in SLE patients. 1
Disease Characteristics and Diagnosis
- What classification criteria does this patient meet for SLE diagnosis?
- What was the patient's initial presentation and how has the disease evolved?
- What is the current ANA titer and pattern? (Remember titers ≥1:640 or specific patterns like nuclear homogeneous have stronger associations with autoimmune diseases) 2
- What specific autoantibodies are present? (anti-dsDNA, anti-Ro, anti-La, anti-RNP, anti-Sm, anti-phospholipid) 1
- Are complement levels (C3, C4) decreased, suggesting active disease? 1
Organ System Involvement
Mucocutaneous
- How would you characterize the skin lesions? Are they LE-specific, LE-nonspecific, LE mimickers, or drug-related? 1
- Have you assessed skin activity and damage using validated indices like CLASI? 1
Renal
- What is the patient's renal function (creatinine, eGFR, urinalysis, protein/creatinine ratio)? 1
- Is there evidence of lupus nephritis? If so, what class? 3
- If nephritis is present, how frequently are you monitoring renal parameters? (Should be at least every 3 months for the first 2-3 years) 1
Neuropsychiatric
- Are there any neuropsychological symptoms (seizures, paresthesias, numbness, weakness, headache, depression)? 1
- Have you assessed for cognitive impairment (attention, concentration, memory, word finding difficulties)? 1
Other Systems
- What other organ systems are affected (hematologic, cardiovascular, pulmonary, gastrointestinal)?
- For patients on antimalarials or glucocorticoids: When was the last eye examination? 1
Disease Activity and Monitoring
- What laboratory tests are you monitoring and at what intervals? 1
- What is the current disease activity status (remission, low activity, or active disease)? 3
- What validated disease activity index are you using (SLEDAI, BILAG, etc.)?
- What damage has accumulated (SLICC Damage Index)?
Treatment Plan
- Is the patient on hydroxychloroquine? (Standard of care associated with reduced mortality) 3
- What is the current glucocorticoid dose and what is your plan to minimize it? 4
- What immunosuppressive agents are being used and why were they selected? 3
- Have you considered biologic therapies like belimumab for active disease? 5, 3
- For lupus nephritis: Have you considered newer approved therapies like voclosporin? 3
Complications and Comorbidities
- What preventive measures are in place for cardiovascular disease? 2
- What is the patient's infection risk and vaccination status? 4
- Is the patient at risk for osteoporosis? What preventive measures are in place? 4
- For female patients: What is the pregnancy plan and contraception status? (Especially important with anti-Ro/La antibodies or antiphospholipid antibodies) 1, 2
Patient Education and Adherence
- What lifestyle modifications have been recommended (UV protection, smoking cessation)? 6
- How is the patient's medication adherence, particularly to hydroxychloroquine? 4
- What is the patient's understanding of their disease and treatment plan?
Common Pitfalls to Avoid
- Don't rely solely on laboratory values to assess disease activity; clinical assessment is equally important
- Don't attribute all symptoms to SLE without ruling out other causes
- Don't forget to monitor for drug toxicities (e.g., antimalarial retinopathy, glucocorticoid side effects)
- Don't overlook the importance of hydroxychloroquine as the cornerstone of SLE therapy 3
- Don't miss the opportunity to screen for and prevent comorbidities that contribute to morbidity and mortality
By anticipating these questions and preparing comprehensive answers, you'll demonstrate a thorough understanding of SLE management that prioritizes reducing morbidity and mortality while improving quality of life for your patient.