Canadian Guidelines for Assessing and Monitoring SLE: A Quiz

October 30, 2018

Take this 6-question quiz to test your knowledge of current recommendations for CV risk assessment, cancer screening, and immunization in patients with lupus.

How much do you know about the Canadian Rheumatology Association Recommendations for the Assessment and Monitoring of Systemic Lupus Erythematosus? Answer the following 6 questions to find out.

Question 1.

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Answer: E. All of the above

“Studies show that early and late damage from SLE is associated with small to moderate increases in mortality and future damage, which may lead to reduced function and quality of life. Higher disease damage is also likely associated with small increases in CV outcomes.”1

Question 2.

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Answer: B. False

“For adults with SLE, we suggest that carotid US not be a part of the CV risk assessment, except in highly selected cases where expertise is available. . . . This test is characterized by a high rate of false-positive results, hence requiring special expertise.”1

Question 3.

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Answer: D. Annually, rather than every 3 years

“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). Recommendations for the general population are based on age and should also apply to women with SLE. The Canadian general population screening interval is every 1–3 years depending on age, risk, and jurisdiction. However, women with SLE, in particular those who receive immunosuppressive medications, are recognized to be a high-risk group.”1

Question 4.

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Answer: A. That no screening or investigations be performed

“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.”1

Question 5.

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Answer: D. 1% to 2%

“Congenital heart block (CHB) occurs in only 1–2% of anti-Ro/La antibodies–positive pregnancies, but the vast majority of CHB cases arise from anti-Ro/La–positive mothers. 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).”1

Question 6.

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Answer: C. Influenza

“We recommend that adults and children with SLE receive an annual inactivated influenza vaccination in a single dose (strong recommendation, moderate-quality evidence).”1 Screening for hepatitis B and hepatitis C is recommended. There is no specific recommendation regarding pneumococcal pneumonia.

References:

1. Keeling SO, Alabdurubalnabi Z, Avina-Zubieta A, et al. Canadian Rheumatology Association Recommendations for the Assessment and Monitoring of Systemic Lupus Erythematosus. JRheumatol. 2018;45:1426-1439. doi:10.3899/jrheum.171459.