Page 47 - e-CPG-SLE-8_5_24

Management of Systemic Lupus Erythematosus

9. MONITORING

Assessment and monitoring in SLE are essential as the disease is
often complicated by flares of varying severity. Few guidelines provide
recommendations on monitoring disease activity, disease damage and
quality of life. 21; 50; 88 - 89
The clinical manifestations of SLE may be related to disease activity,
organ damage, drug toxicity and quality of life. The monitoring includes
new clinical manifestations, laboratory investigations, disease activity,
organ damage, co-morbidities and drug AEs.

9.1 Clinical Features

SLE can present in various clinical manifestations (refer to Figure 1).
Thus, a thorough history and physical examination must be undertaken
at each clinic visit. Any new onset or changes in clinical manifestation
would require further evaluation.

9.2 Laboratory Investigations
Laboratory tests that are commonly done for monitoring are FBC,
RP, LFT, acute phase reactants (ESR and CRP), complements and
urinalysis.

• Full blood count
FBC should be assessed at every visit to detect cytopenia which is
associated with SLE flare or concomitant drug treatment.
The haematological flares during monitoring of patients with SLE are
indicated by the following parameters: 21; 23
 haemolytic anaemia with reticulocytosis
3
 leukopenia <4000/mm total on >2 occasions*
 lymphopenia <1500/mm on >2 occasions*
3
 thrombocytopenia <100 000/mm3*
*in the absence of offending drugs
• Biochemistry and urinalysis
Serum albumin and creatinine provide information on the presence and
prognosis of renal involvement. Urinalysis can be used to detect early
renal manifestations.

Renal biopsy is indicated during monitoring of patients with SLE with
the presence of these criteria: 21; 23
 persistent proteinuria >0.5 g/day or >3+ if quantitation not
performed

30