General assessment | ||
Best clinical practice dictates that all adult and pediatric patients with SLE have a complete history, physical, and laboratory evaluation at baseline and during each followup visit. Careful interpretation of the clinical and laboratory findings is required to ensure proper attribution of the signs, symptoms, and investigation results towards SLE or other comorbid conditions. | ||
SLE healthcare provider | (1) We recommend that all adult patients suspected of SLE be referred to an SLE specialist, most often a rheumatologist, to confirm diagnosis and be involved in ongoing care. | Strong recommendation, moderate-quality evidence |
Disease activity | (2) For adult and pediatric patients with SLE, we suggest assessing disease activity with a validated instrument of disease activity during baseline and followup visits. | Conditional recommendation, low-quality evidence |
Damage | (3) For adult and pediatric patients with SLE, we suggest assessing disease damage annually with a validated measure. | Conditional recommendation, low-quality evidence |
Cardiovascular (CV) risk assessment | ||
Best practice dictates that a CV risk assessment be performed in adult patients upon diagnosis of SLE. | ||
CV risk assessment | (4) For adults with SLE, we recommend that indicators of obesity, smoking status, arterial hypertension, diabetes, and dyslipidemia be measured upon diagnosis of SLE, and be reassessed periodically according to current recommendations in the general population and be used to inform the CV risk assessment. | Strong recommendation, high-quality evidence |
(5) For adults with SLE, we suggest that carotid ultrasonography not be a part of the CV risk assessment, except in highly selected cases where expertise is available. | Conditional recommendation, low-quality evidence | |
Osteoporosis | ||
Osteoporosis | (6) For all adult patients with SLE, we suggest assessing for risk of osteoporosis and fractures every 1 to 3 years using a detailed history and focused physical examination, and measuring bone mineral density in patients with other risk factors according to recommendations in the general population. | Conditional recommendation, low-quality evidence |
(7) For all adults with SLE, we suggest screening for 25-hydroxy vitamin D as part of the assessment for risk of osteoporosis and fractures. | Conditional recommendation, low-quality evidence | |
Osteonecrosis | ||
Best clinical practice dictates that adult and pediatric patients with SLE, in particular patients who have a history of glucocorticoid exposure, receive information about the symptoms of osteonecrosis, including progressive or sudden deep joint pain that is worse with weight-bearing. | ||
Osteonecrosis | (8) For adult and pediatric patients with SLE who do not have clinical symptoms suggestive of osteonecrosis, we suggest not screening for or performing investigations for osteonecrosis. For patients who have suspected clinical symptoms of osteonecrosis, we suggest radiographs as the initial imaging modality rather than MRI or bone scan with SPECT, according to recommendations in the general population. | Conditional recommendation, low-quality evidence |
Peripartum assessment | ||
Best practice dictates that all women living with SLE who are planning a pregnancy or who become pregnant should have their individual situations discussed with experts in the area, with referral to an SLE care provider and obstetrical care providers, and an overall plan should be made for their pregnancy care. Best practice dictates that for women with SLE, a complete history, physical, and laboratory evaluation be provided immediately prior to pregnancy and each trimester of pregnancy, and when flare is suspected during pregnancy. Laboratory evaluation should include antiphospholipid antibodies (see Best Clinical Practice General Assessment), with further testing depending on results. | ||
Peripartum assessments | (9) For women with SLE, we recommend that anti-Ro and anti-La antibodies be measured prior to pregnancy or during the first trimester. | Strong recommendation, low-quality evidence |
(10) For pregnant women with SLE, we suggest that uterine and umbilical Doppler studies be performed in the second or third trimester, or at the time of a suspected flare. | Conditional recommendation, low-quality evidence | |
(11) For women with prior or active lupus nephritis who are pregnant, we suggest measuring serum creatinine and urine protein to creatinine ratio every 4–6 weeks, or more frequently if clinically indicated. We suggest blood pressure and urinalysis be measured prior to pregnancy and every 4–6 weeks until 28 weeks, every 1–2 weeks until 36 weeks, and then weekly until delivery. | Conditional recommendation, low-quality evidence | |
Cervical cancer screening | ||
Cervical cancer screening | (12) For all female adult patients with SLE who are or have been sexually active, regardless of sexual orientation, we suggest annual cervical cancer screening rather than screening every 3 years, at least up to the age of 69. | Conditional recommendation, low-quality evidence |
Infection screening and vaccination | ||
Infection screening/vaccination | (13) We recommend that adults and children with SLE receive an annual inactivated influenza vaccination in a single dose. | Strong recommendation, moderate-quality evidence |
(14) For adult and pediatric patients with a diagnosis of SLE and high-risk behaviors for hepatitis B virus acquisition, we recommend screening for HbsAg and repeating according to recommendations for the general population. For patients being considered for immunomodulatory therapy, we suggest screening before starting treatment. | Conditional recommendation, low-quality evidence | |
(15) For adults and pediatric patients with a diagnosis of SLE and high-risk behaviors for hepatitis C virus (HCV) acquisition, we recommend screening for HCV and repeating according to recommendations in the general population. For all other adult and pediatric patients with a diagnosis of SLE, we suggest screening for HCV and repeating according to recommendations in the general population. | Conditional recommendation, low-quality evidence |
MRI: magnetic resonance imaging; SPECT: single photon emission–computed tomography.