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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.