Role of specialty care in the management of patients with systemic lupus erythematosus.

OBJECTIVE: To determine the role of rheumatologists in the management of systemic lupus erythematosus (SLE).

METHODS: The lupus clinic database was searched for patients with 3 consecutive visits (every 3-4 months) of which the first 2 visits recorded a SLE Disease Activity Index (SLEDAI) of 0. The clinic notes were examined by a physician blinded to the SLEDAI score at the third visit. The physician classified the rheumatologist's action by the following scale: 1 = no change, 2 = closer followup, 3 = new investigations, 4 = increase medications, 5 = lower medications. All interventions (2-5) were further scored as being related to or independent of SLE.

RESULTS: Of the 142 SLE patients identified, 70 patients remained inactive (SLEDAI = 0) and 72 patients experienced flare (SLEDAI > 0) at the third visit. In total, 74% of patients, regardless of the status of disease activity, required intervention; 96% of interventions in patients with clinical flare, 72% with serological flare, and 63% with inactive disease were due to management of SLE. The most frequent intervention related to SLE in patients with clinical flare was increasing medication, while in inactive SLE lowering medication was the most common intervention.

CONCLUSION: Even after a period of relative disease quiescence the majority of patients with lupus require active intervention during a subsequent routine clinic visit. Most interventions are related to the management of SLE. Therefore ongoing monitoring by rheumatologists in the management of lupus seems prudent.