Summary of recommendations with strength of evidence for the diagnosis and monitoring of SLE in Canada
| Recommendation | Strength of Recommendation; Quality of Evidence |
|---|---|
| We recommend that all adult and pediatric patients suspected of SLE be referred to a lupus specialist, most often a rheumatologist, to confirm diagnosis and be involved in ongoing care | strong recommendation; moderate quality evidence |
| For adult and pediatric patients with SLE, we suggest assessing disease activity with a validated instrument of disease activity during baseline and follow up visits. | conditional recommendation, low quality evidence |
| For adult and pediatric patients with SLE, we suggest assessing disease activity with a validated instrument of disease activity during baseline and follow up visits | conditional recommendation, low quality evidence |
| For adult lupus patients, we recommend that indicators of obesity, smoking status, diabetes, blood pressure and a basic lipid profile be measured upon diagnosis of SLE and be reassessed periodically according to current recommendations in the general population and be used to inform the cardiovascular risk assessment. | strong recommendation, moderate quality evidence |
| For adult patients with SLE, we suggest assessing the risk of osteoporosis and fractures every 1 to 3 years using a detailed history and focused physical examination, and measuring bone mineral density in patients with other risk factors according to recommendations in the general population. | conditional recommendation, low quality evidence |
| For all adults with SLE, we suggest screening 25-hydroxyvitamin D as part of the assessment for risk of osteoporosis and fractures | strong recommendation, moderate quality evidence |
| For adults and paediatric patients with a diagnosis of SLE and high risk behaviours for HCV acquisition, we recommend screening for Hepatitis C and repeating according to recommendations in the general population. For all other adult and paediatric patients with a diagnosis of SLE we suggest screening for Hepatitis C and repeating according to recommendations in the general population | conditional recommendation, low quality evidence |
| For adult patients with SLE who do not have clinical symptoms suggestive of osteonecrosis, we suggest not screening for or performing investigations for osteonecrosis. For patients who have suspected clinical symptoms of osteonecrosis, we suggest radiographs as the initial imaging modality rather than MRI or bone scan with SPECT according to recommendations in the general population. | conditional recommendation, low quality evidence |
| For women with SLE, we suggest that anti-Ro and anti-La antibodies be measured immediately prior to pregnancy or during the first trimester. | conditional recommendation, low quality evidence |
| For pregnant women with SLE, we suggest that uterine and umbilical Doppler studies be performed in the second or third trimester, or at the time of a suspected flare. | conditional recommendation; low quality evidence |
| For women with prior or active lupus nephritis who are pregnant, we suggest measuring serum creatinine and urine protein to creatinine ratio every 4–6 weeks, or more frequently if clinically indicated. We suggest blood pressure and urinalysis be measured prior to pregnancy and every 4–6 weeks until 28 weeks, every 1–2 weeks until 36 weeks and then weekly until delivery. | conditional recommendation; low quality evidence |
| 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 |
| We recommend that adults and children with SLE receive an annual inactivated influenza vaccination in a single dose. | strong recommendation, moderate quality evidence |
| For adults and paediatric patients with a diagnosis of SLE and high risk behaviours for HBV and/or HCV acquisition, we recommend screening for Hepatitis B surface antigen and/or Hepatitis C and repeating according to recommendations for the general population. For patients being considered for immunomodulatory therapy, we suggest screening for HBV before starting treatment | conditional recommendation, low quality evidence |