SLEOsteoporosis and Cardiovascular Disease Care in Systemic Lupus Erythematosus According to New Quality Indicators
Section snippets
Patient Population
Of 1759 patients followed for SLE in the Brigham and Women's Hospital Arthritis Center, we identified 867 seen in Brigham and Women's Hospital Arthritis Center from June 2007 to July 2008 who had SLE (≥4 of 11 of the updated 1997 ACR Classification Criteria for SLE (15, 16) previously confirmed by medical record review by board-certified rheumatologists) and ≥2 outpatient visits to the rheumatology clinic in the year before the date of medical record review. The first 200 of these 867 subjects
Results
The demographics of our patient population are shown in Table 2. The mean cumulative dose of prednisone was 2702.5 mg in the 12 months before review, equal to a mean of 7.4 mg/d of prednisone among glucocorticoid users. Seventeen (n = 185 patients) rheumatology attendings and 9 (n = 15 patients) rheumatology fellows at the Brigham and Women's Hospital were involved in the care of these patients. It took 1 full-time reviewer approximately 200 hours to complete the medical record reviews. There
Discussion
In this study of 200 patients with SLE actively followed at our teaching hospital, we assessed care for osteoporosis and CVD management according to newly proposed QI set for care of patients with SLE. Other areas covered in the QI set included SLE diagnosis, general preventive strategies, drug toxicity monitoring, renal disease, and reproductive health QIs. Given the importance of osteoporosis and CVD prevention for patients with SLE and the time it took to review medical records, we focused
Acknowledgments
We are grateful to all the patients in our study. We also thank Bonnie Bermas, MD, Jonathan S. Coblyn, MD, Elena Massarotti, MD, and Peter Schur, MD for their insights and for seeing the lion's share of these patients. Elizabeth Karlson, MD and Lori B. Chibnik, PhD provided much helpful advice on data collection, analysis, and statistical methods. We appreciate the generosity of the Lupus Foundation of New England and Arthritis Foundation of Massachusetts, who awarded a summer student research
References (31)
- et al.
Medication use patterns for osteoporosis: an assessment of guidelines, treatment rates, and quality improvement interventions
Mayo Clin Proc
(2005) - et al.
The bimodal mortality pattern of systemic lupus erythematosus
Am J Med
(1976) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Does treatment with bisphosphonates endanger the human pregnancy?
J Obstet Gynaecol Can
(2008) - et al.
Prevention and treatment of adverse effects of corticosteroids in systemic lupus erythematosus
Bailliere Clin Rheumatol
(1998) Strategies for preventive care in systemic lupus erythematosus
J Musculoskel Med
(2008)- et al.
Quality of care in the rheumatic diseases: current status and future directions
Curr Opin Rheumatol
(2008) Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update
Arthritis Rheum
(2001)- et al.
Oral corticosteroids and fracture risk: relationship to daily and cumulative doses
Rheumatology (Oxford)
(2000) - et al.
Steroid induced osteoporosis: an opportunity for prevention?
Ann Rheum Dis
(1995)
Premature atherosclerotic cardiovascular disease in systemic lupus erythematosus
Arthritis Rheum
Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus
Arthritis Rheum
Risk factors for cardiovascular disease in systemic lupus erythematosus
Circulation
Disease-specific quality indicators, guidelines, and outcome measures in systemic lupus erythematosus (SLE)
Clin Exp Rheumatol
Guidelines for referral and management of systemic lupus erythematosus in adults
Arthritis Rheum
Cited by (0)
Supported by NIH Grants P60 AR047782, K24 AR055989-01, BIRCWH K12 HD051959 (supported by NIMH, NIAID, NICHD, and OD). Ms. Demas was the recipient of a Lupus Foundation or New England/Arthritis Foundation of Massachusetts jointly sponsored summer student award.