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Clinical Sciences
CS-36 Recommendations for the assessment of systemic lupus erythematosus in canada
  1. Stephanie Keeling1,
  2. Zainab Alabdurubalnabi2,
  3. Antonio Avina-Zubieta2,
  4. Susan Barr3,
  5. Louise Bergeron4,
  6. Sasha Bernatsky5,
  7. Josiane Bourre-Tessier6,
  8. Ann Clarke3,
  9. Alexandra Baril-Dionne6,
  10. Jan Dutz2,
  11. Stephanie Ensworth2,
  12. Aurore Fifi-Mah3,
  13. Paul R Fortin7,
  14. Dafna Gladman8,
  15. Derek Haaland9,
  16. John G Hanly10,
  17. Linda T Hiraki11,
  18. Sara Hussein6,
  19. Kimberly Legault9,
  20. Deborah Levy11,
  21. Lily Lim12,
  22. Mark Matsos9,
  23. Emily G McDonald13,
  24. Jorge Medina-Rosas8,
  25. Jordi Pardo Pardi14,
  26. Christine Peschken12,
  27. Christian Pineau5,
  28. Janet Pope15,
  29. Tamara Rader16,
  30. Jen Reynolds2,
  31. Earl Silverman11,
  32. Konstantinos Tselios8,
  33. Manon Suitner6,
  34. Murray Urowitz8,
  35. Zahi Touma8,
  36. Evelyne Vinet5 and
  37. Nancy Santesso17
  1. 1Divison of Rheumatology, Department of Medicine, University of Alberta
  2. 2Division of Rheumatology, Department of Medicine, University of British Columbia
  3. 3Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary
  4. 4Louise Bergeron, Canadian Arthritis Patient Alliance
  5. 5Division of Rheumatology, Department of Medicine, McGill University
  6. 6Division of Rheumatology, Department of Medicine, Université de Montreal
  7. 7Division of Rheumatology, Department of Medicine, Université Laval
  8. 8Institute of Health Policy, Management and Evaluation, University of Toronto
  9. 9Division of Rheumatology, Department of Medicine, McMaster University
  10. 10Division of Rheumatology, Department of Medicine, Dalhousie University
  11. 11Division of Rheumatology, Hospital for Sick Children, Department of Pediatrics University of Toronto
  12. 12Division of Rheumatology, Department of Medicine, University of Manitoba
  13. 13General Internal Medicine, McGill University Health Centre, McGill University
  14. 14Cochrane Musculoskeletal Group, University of Ottawa
  15. 15Division of Rheumatology, Department of Medicine, Western University
  16. 16Canadian Agency for Drugs and Technologies in Health
  17. 17Department of Health Research Methods, Evidence and Impact, McMaster University

Abstract

Background To develop GRADE-based recommendations for the diagnosis and monitoring of systemic lupus erythematosus patients in Canada.

Methods Recommendations were developed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. The Canadian SLE Working Group (panel of Canadian rheumatologists and patient representative from CAPA (Canadian Arthritis Patient Alliance)) was created. A series of questions for recommendation development were identified based on the results of a survey of SLE practice patterns of members of the Canadian Rheumatology Association (CRA). Systematic literature reviews of randomized controlled trials and observational studies were conducted. Evidence to Recommendation Tables were prepared and presented to the panel at two face-to-face meetings for discussion and voting during and post-meeting online.

Results There were a total of fourteen recommendations for assessing and monitoring lupus patients (table 1). Three recommendations focused on disease activity and damage assessment suggesting that a validated disease activity score per visit and annual damage score were important in evaluating the patient. One strong recommendation was made for cardiovascular risk assessment with conditional recommendations for osteoporosis (2) and osteonecrosis (1). Three conditional recommendations were made regarding peripartum assessments, one on cervical cancer screening and two on hepatitis B and C screening. A strong recommendation was made for annual influenza vaccination.

View this table:
Abstract CS-36 Table 1

Summary of recommendations with strength of evidence for the diagnosis and monitoring of SLE in Canada

Conclusions These are the first GRADE-based recommendations for the diagnosis and monitoring of SLE internationally. Evidence is largely of moderate to low quality resulting in more conditional versus strong recommendations. Further studies of higher quality and special attention to pediatric lupus populations are needed.

Acknowledgements The authors are members of the Canadian SLE Working Group which was created to develop these recommendations.

http://dx.doi.org/10.1136/lupus-2018-lsm.71

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