Recommended investigations and followup for optimal monitoring CHD risk in patients with SLE.
| Variable | Frequency of Assessment | Followup |
|---|---|---|
| Demographic data (age, sex, family history, BMI, smoking habits) | Initial evaluation | As needed |
| Blood pressure | At each clinic visit | 3–6 mos, more stringently if arterial HTN |
| Fasting glucose | At each clinic visit | 3–6 mos, more stringently if DM (add HbA1c) |
| Lipid profile (TC, HDL, LDL, TG) | At each clinic visit | 3–6 mos |
| Homocysteine | Annually? | |
| Disease activity | At each clinic visit | 3–6 mos, use of an accepted composite index is recommended. Anti-dsDNA antibodies and complement C3 and C4 levels should be included |
| Cumulative damage | Annually | Use of an accepted index, like SLICC, is recommended |
| Antiphospholipid antibodies | Initially | If positive, annual reevaluation. Anticardiolipin, anti-β2GPI, and LA should be included |
| hsCRP | At each clinical visit | |
| Renal disease | Serum creatinine and urinalysis at each clinic visit | 24-h urine protein and other investigations, if indicated |
| Medications | Review at each clinic visit | HCQ should be encouraged, corticosteroid usage to be minimized accordingly to disease activity control |
| Carotid IMT and plaque assessment | In patients with > 1 classic risk factor, or postmenopausal status or renal impairment | Assessment of total plaque area is recommended |
| Other imaging techniques | As needed |
CHD: coronary heart disease; SLE: systemic lupus erythematosus; BMI: body mass index; TC: total cholesterol; HDL: high-density lipoprotein; LDL: low-density lipoprotein; TG: triglycerides; hsCRP: high sensitivity C-reactive protein; IMT: intima-media thickness; HTN: hypertension; DM: diabetes mellitus HbA1c: glycosylated hemoglobin A1c; C3: complement factor 3; C4: complement factor 4; SLICC: Systemic Lupus International Collaborating Clinics; anti-β2GPI: anti-β2 glycoprotein I; LA: lupus anticoagulant; HCQ: hydroxychloroquine.