“Patients with persistently abnormal urinalysis or creatinine should have a urine protein/creatinine ratio or 24-hour proteinuria [test], urine microscopy, renal ultrasound, and be considered for biopsy referral,” Dr. Mosca said. “Patients with established nephropathy should have urine protein/creatinine ratio or 24-hour proteinuria [test], immunological studies [C3, C4, anti-dsDNA], and urine microscopy at least every 3 months for the first 2-3 years; and patients with established chronic kidney disease should be followed according to the National Kidney Foundation guidelines for chronic kidney disease.”
▸ Neuropsychological manifestations. Although the rate of neurocognitive impairment in SLE is high, “monitoring neurocognitive status is difficult because there are no standardized assessment tools for this population,” Dr. Mosca stated.
All SLE patients should be monitored for neuropsychological symptoms using a focused history. Additionally, “cognitive impairment may be assessed by evaluating memory, attention, concentration, and word finding difficulties; and if there is suspicion of cognitive impairment, the patient should be referred to a specialist for a more detailed assessment,” she said.
▸ Eye assessment. Eye damage in patients with lupus varies from minor problems to severe retinopathy. A small percentage of lupus patients develop scleritis, retinal vasculitis, cotton wool spots at the back of the eyeball, or retinal bleeding and swelling of the optic disc.
According to the guidelines, patients on steroids or antimalarial drugs should undergo a baseline eye examination according to standard recommendations.
Annual follow-up eye exams are recommended in selected patients taking steroids and those at high risk for eye problems.
“In patients taking antimalarial drugs who are low risk for eye problems, no further testing is required until after 5 years from baseline, at which point yearly examinations are recommended,” Dr. Mosca said.
In addition to facilitating good clinical practice, the recommendations for monitoring SLE are expected to “improve the quality control of care for lupus patients and to standardize the collection and comparison of data in observational studies,” Dr. Mosca concluded.
The recommendations, which are expected to be published in the Annals of Rheumatic Disease later this year, were developed by an expert panel using a three-staged consensus approach comprising a discussion of relevant categories, a comprehensive literature review and level of evidence assessment, and the integration of the evidence with expert opinion, said Dr. Mosca.
She reported having no financial conflicts of interest to disclose.