Aiming to improve outcomes for lupus patients, the Lupus Initiative of the American College of Rheumatology has launched a series of educational tools for lupus diagnosis and treatment in primary care. The focus is on coordination of care, as well as cultural competence and empowering patients.
This is the second article in a three-part series providing an overview of the role of the primary care physician in diagnosis, treatment, and patient self-management.
Part 2: The Role of the Primary Care Physician in Treatment
Due to the systemic nature of lupus, the primary care physician will continue to play a vital role in patient care after a rheumatologist confirms the diagnosis. A first priority is to guide the patient in assembling a team of health care providers.
In addition to the rheumatologist, patients may need a nephrologist, neurologist, cardiologist, dermatologist, and more, depending on the individual situation. It is crucial for the primary care physician to remain involved continually, to assure good communication across this team. Awareness and knowledge of prescribed drugs in treatment, their interactions, and their implications for overall health should be a major consideration. The primary care physician plays a critical role in managing and monitoring for the broad health implications of lupus. This role includes the following:
• Preventing and minimizing flares. Like other autoimmune diseases, lupus symptoms wax and wane. Supporting patients in preventing and managing flares through good self-care is critical.
• Monitoring and managing hypertension. This is especially important in the lupus patient population, due to the increased risk for renal disease and cardiovascular disease. It is crucial for the primary care practitioner to manage hypertension aggressively and to encourage the patient’s involvement through healthy lifestyle choices.
• Focusing on good nutrition. Eating a good nutritious diet may be the single most important action that lupus patients can take to support their health. A conversation about diet, both quality and quantity, should be part of all patient visits.
• Cardiovascular health. The risk for cardiovascular disease is accelerated in those with lupus. Increased vigilance in monitoring for traditional risk factors is required.
• Kidney health. The lupus patient population suffers disproportionately from renal disease; therefore, it is important to monitor for kidney involvement in those with known or suspected lupus. Again, it is important to monitor and manage hypertension in the lupus patient.
• Cancer. Lupus patients are at increased risk for cancer and may require screenings beyond the normal guidelines.
• Bone health. The prevalence of osteoporosis is markedly higher in patients with SLE. This is of special concern because most lupus patients are women, a group already at increased risk for osteoporosis.
• Neurological health. Although not typically the first to appear, neurological symptoms are common in lupus. Neurological complications of lupus can include memory loss, difficulty focusing, depression, bizarre behavior, and seizure. It is critical to be aware of and alert for these neurological symptoms.
• Reproductive health. Because most patients with lupus are women of child-bearing age, reproductive health is a major concern. Pregnancy remains an option for most women with lupus. Uncomplicated pregnancies are possible if done in a thoughtful, planned way with the support of a multi-disciplinary team including the primary care physician, OB/GYN, and rheumatologist. The team’s continued involvement during the pregnancy, birth, and post-birth is critical.
For more information on optimal diagnosis and treatment of lupus, visit The Lupus Initiative at http://thelupusinitiative.org.