Systemic Lupus Erythematosus Follow Up

Monitoring

Lifelong monitoring is required for systemic lupus erythematosus patients. The frequency of visits depends on the disease activity, severity and extent, response to treatment, type of treatment, and monitoring of toxicity. 

The most important tool in the management of systemic lupus erythematosus is a careful, frequent clinical and laboratory evaluation to detect disease flares, drug side effects, and appearance of infections, and to tailor management based on the patient response. It is therefore essential to do active surveillance of opportunistic infections and adjust current therapy (eg corticosteroids and immunosuppressants) according to the severity of organ involvement during systemic lupus erythematosus flares. Patients with severe systemic lupus erythematosus, complications, comorbidities, and drug toxicity will require more frequent follow-ups. 

Monitoring during clinic visits should include history-taking, physical examination, and laboratory tests (eg complete blood count [CBC], platelet count, creatinine measurement, urinalysis, renal and liver function tests, immunology, electrocardiography, and imaging). For active systemic lupus erythematosus disease, monitoring can be done every 1-3 months after diagnosis or flare while for low or no disease activity or with stable treatment course, monitoring can be done every 6-12 months. 

Physicians may be aided by at least 1 of the following several global or body system-specific indices developed for long-term observation of SLE: SLEDAI, BILAG, PGA, and ECLAM. 

The results of laboratory tests that may precede a disease flare include a decrease in serum complement levels, an increase in anti-dsDN, an increase in ESR, a decrease in hemoglobin level, leukocyte, or platelet counts, an increase in creatine phosphokinase (CPK) levels, and the appearance of microscopic hematuria or proteinuria.

Complications

Toxicity

Patients on long-term glucocorticoids should be monitored for electrolyte, glucose, and lipid levels to identify metabolic conditions. Bone densitometry may be requested to identify osteoporosis and monitor response to treatment. 

Patients on Hydroxychloroquine should have ophthalmological screening (eg visual fields examination and/or spectral domain-optical coherence tomography) performed at baseline, after 5 years, and then annually in those with no risk factors for retinal toxicity. 

Patients on immunosuppressants should be monitored for hematologic, liver and renal toxicity, and the occurrence of infection.