Systemic lupus erythematosus

Structured methods for following patients with SLE have been developed that take into account previous damage as well as ongoing disease activity. Several are available:

• Systemic Lupus International Collaborating Clinics (SLICC, endorsed by the American College of Rheumatology), which can be downloaded from the college's website American College of Rheumatology Opens in new window

• Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)

• British Isles Lupus Assessment Group (BILAG) index

• Systemic Lupus Activity Measure (SLAM)

The European Alliance of Associations for Rheumatology (EULAR) guideline recommends that disease activity should be assessed at each clinic visit, recognising that frequency is at the physician’s discretion, with evaluation of organ damage assessed at least annually.[53]Fanouriakis A, Kostopoulou M, Andersen J, et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis. 2024 Jan 2;83(1):15-29. https://ard.eular.org/article/S0003-4967(24)00386-8/fulltext http://www.ncbi.nlm.nih.gov/pubmed/37827694?tool=bestpractice.com There is as yet no consensus on the value of serological tests and complement levels to follow-up patients. In general terms, changing levels should prompt more vigilant monitoring.

In assessing a patient with a presumed flare of symptoms, it is important to exclude infection and comorbidity as an explanation.

Patients with lupus nephritis should have their renal function monitored (renal biopsy, kidney function tests, urinalysis).