Test your knowledge of the assessment and follow-up of patients with SLE with 7 questions based on recent British Society for Rheumatology guidelines.
Reference1. Gordon C, Amissah-Arthur MB, Gayed M, et al, for the British Society for Rheumatology Standards, Audit and Guidelines Working Group. The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. Rheumatology. 2018;57:e1-e45. doi: 10.1093/rheumatology/kex286.For an overview of the highlights of the guideline, please see Lupus Management Guidelines From the British Society for Rheumatology.
In January 2018, the British Society for Rheumatology published new guidelines for the diagnosis, monitoring, and treatment of non-renal manifestations of systemic lupus erythematosus (SLE) in adults.1 Here, we offer a 7-question quiz based on these guidelines that focuses on the monitoring of SLE.
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True or false? Patients with active disease should be assessed every 1 to 3 months after diagnosis or a flare.
TRUE: Those with active disease should be assessed at least every 1 to 3 months, with blood pressure, urinalysis, renal function, anti-dsDNA antibodies, complement levels, C-reactive protein, complete blood cell count, and liver function tests. Patients with stable low disease activity or in remission can be assessed less frequently: for example, every 6 to 12 months.
FALSE: Even patients who achieve early remission remain at significant risk for flare and the development of damage.
FALSE: Although the ESR is often elevated in patients with active SLE, it can also reflect persistent polyclonal hypergammaglobulinemia and is not a reliable marker of disease activity. Moreover, an elevated ESR does not discriminate between active lupus and infection.
True or false? The presence of antiphospholipids is associated with thrombotic events, damage, and adverse outcomes in pregnancy.
TRUE: Antiphospholipids are associated with thrombotic events, damage, and adverse outcomes in pregnancy. If previous tests were negative, patients should be tested again before pregnancy or surgery, or if a new severe manifestation or a vascular event occurs.
True or false? Anti-Ro and anti-La antibodies are associated with neonatal lupus (including congenital heart block) and should be measured before pregnancy.
TRUE: Anti-Ro and anti-La antibodies should be measured in women who are planning pregnancy or in early pregnancy because they may be transferred across the placenta and are associated with congenital heart block in about 1% to 2% of infants. Neonatal lupus rash develops in approximately 10% of infants born to mothers with these antibodies (especially if they are exposed to UV light), and laboratory abnormalities (cytopenias and abnormal liver function tests) have also been found in infants exposed to these antibodies.
True or false? Serum immunoglobulin levels should be measured before treatment is started with drugs such as mycophenolate mofetil (MMF), cyclophosphamide (CYC), and rituximab.
TRUE: Drugs such as MMF, CYC, and rituximab pose the risk of inducing immunoglobulin deficiency, which may increase the risk of infection. Thus, serum immunoglobulin levels should be measured before these drugs are started. The initial repeated measurement of the serum immunoglobulins should be obtained about 3 to 6 months later and can then be spaced out to annual checks.
True or false? Management of modifiable risk factors for comorbidities, including hypertension, dyslipidemia, diabetes, high BMI, and smoking, should be reviewed at baseline and at least annually.
TRUE: Modifiable risk factors for comorbidities, such as hypertension, dyslipidemia, diabetes, high BMI, and smoking, should be reviewed at baseline and at least annually thereafter. These comorbidities may occur at a younger age in patients with lupus than in the general population, although it should be noted that no evidence from randomized, controlled trials suggests that more intensive screening improves outcomes in patients with lupus.