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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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