RT Journal Article
SR Electronic
T1 Practice Variations in the Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus in Canada
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1440
OP 1447
DO 10.3899/jrheum.171307
VO 45
IS 10
A1 Stephanie O. Keeling
A1 Asvina Bissonauth
A1 Sasha Bernatsky
A1 Ben Vandermeer
A1 Paul R. Fortin
A1 Dafna D. Gladman
A1 Christine Peschken
A1 Murray B. Urowitz
YR 2018
UL http://www.jrheum.org/content/45/10/1440.abstract
AB Objective. To evaluate the diagnosis, monitoring, and treatment of systemic lupus erythematosus (SLE) in Canada.Methods. A 63-question electronic survey was developed with the Canadian Rheumatology Association and others. Descriptive analyses of responses were performed.Results. Survey respondents (n = 175) reported varying practices in the diagnosis, monitoring, and treatment of SLE. Performance of laboratory investigations for diagnosis and monitoring varied, with 78% of responders performing them at least every 6 months. Validated measures of SLE disease activity and damage were not commonly used. Most common first-line agents besides steroids for induction therapy for class III or IV lupus nephritis included intravenous cyclophosphamide and mycophenolate mofetil. Antimalarial use was common, with 96% of respondents using these in active skin disease. Over 60% of respondents indicated that 80–100% of their patients were taking antimalarials, while another 25% indicated they used these drugs in up to 80% of their patients. There were 71% of responders who reported completing frequent (6–12 mos) ophthalmology screening in patients taking antimalarials. Biologics were infrequently used. Responders were more likely to stop azathioprine and chloroquine than hydroxychloroquine in pregnant patients with SLE. Other aspects of routine care including vaccination and cardiovascular risk management varied considerably. The majority (80%) agreed that a dedicated multidisciplinary care team would improve SLE care.Conclusion. Considerable practice variation in SLE management was noted. This may help inform future recommendations for the diagnosis, monitoring, and treatment of SLE in Canada.