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Management of Systemic Lupus Erythematosus

10.3 Lactation

Breastfeeding is encouraged and not contraindicated in patients with
SLE as long as the disease control can be maintained with medication
compatible with lactation. Refer to Appendix 7 on Medication in SLE
for medication compatible with lactation.

10.4 Adolescents

SLE is diagnosed during childhood in 15 to 20% of patients. 116, level III
A co-ordinated transition from paediatric to adult care providers starting
during adolescence has been recommended to ensure the patients’
physical, psychosocial, educational and vocational needs are met. 117
Two observational studies showed that a structured transition
programme or clinic was important to improve long-term outcomes.
In a cross-sectional study on childhood-onset SLE, patients who
experienced difficulty during transition compared with those without
difficulty were more likely to report ‘poor overall control’ of symptoms
(p=0.03) and involvement of multiple organ systems (p=0.05). Patients
who were directly referred to an adult physician by a paediatric
rheumatologist rather than self-referred reported ‘well controlled’
overall symptoms (p=0.01) and lower hospitalisation (p=0.04). 118, level
III Another single-centre, pre-post study on childhood-onset SLE cohort
with no formal transition programme showed that 72% were lost to
follow-up. 119, level II-3

Two programmes described in a systematic review of transitional
care in rheumatology showed improvements in the following
outcomes: 120, level II-3
• health-related quality of life, arthritis-related knowledge and
satisfaction with rheumatic care in adolescents and parents
• vocational readiness
• physical, psychosocial and disease-specific health status

Young people with rheumatic and musculoskeletal diseases which
include SLE should have access to co-ordinated transitional care,
delivered through partnership with healthcare professionals. The
transition process should start as early as possible. 117

Recommendation 14
• A structured transition programme may be implemented to facilitate
transfer of care from paediatric to adult health care providers
during adolescence in patients with childhood-onset systemic lupus
erythematosus.

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