Canadian Rheumatology Association Recommendations for the Assessment and Monitoring of Systemic Lupus Erythematosus

Stephanie O Keeling, Zainab Alabdurubalnabi, Antonio Avina-Zubieta, Susan Barr, Louise Bergeron, Sasha Bernatsky, Josiane Bourre-Tessier, Ann Clarke, Alexandra Baril-Dionne, Jan Dutz, Stephanie Ensworth, Aurore Fifi-Mah, Paul R Fortin, Dafna D Gladman, Derek Haaland, John G Hanly, Linda T Hiraki, Sara Hussein, Kimberly Legault, Deborah Levy, Lily Lim, Mark Matsos, Emily G McDonald, Jorge Medina-Rosas, Jordi Pardo Pardi, Christine Peschken, Christian Pineau, Janet Pope, Tamara Rader, Jen Reynolds, Earl Silverman, Konstantinos Tselios, Manon Suitner, Murray Urowitz, Zahi Touma, Evelyne Vinet, Nancy Santesso
Journal of Rheumatology 2018, 45 (10): 1426-1439

OBJECTIVE: To develop recommendations for the assessment of people with systemic lupus erythematosus (SLE) in Canada.

METHODS: Recommendations were developed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. The Canadian SLE Working Group (panel of Canadian rheumatologists and a patient representative from Canadian Arthritis Patient Alliance) was created. Questions for recommendation development were identified based on the results of a previous survey of SLE practice patterns of members of the Canadian Rheumatology Association. Systematic literature reviews of randomized trials and observational studies were conducted. Evidence to Decision tables were prepared and presented to the panel at 2 face-to-face meetings and online.

RESULTS: There are 15 recommendations for assessing and monitoring SLE, with varying applicability to adult and pediatric patients. Three recommendations focus on diagnosis, disease activity, and damage assessment, suggesting the use of a validated disease activity score per visit and annual damage score. Strong recommendations were made for cardiovascular risk assessment and measuring anti-Ro and anti-La antibodies in the peripartum period and conditional recommendations for osteoporosis and osteonecrosis. Two conditional recommendations were made for peripartum assessments, 1 for cervical cancer screening and 2 for hepatitis B and C screening. A strong recommendation was made for annual influenza vaccination.

CONCLUSION: These are considered the first guidelines using the GRADE method for the monitoring of SLE. Existing evidence is largely of low to moderate quality, resulting in more conditional than strong recommendations. Additional rigorous studies and special attention to pediatric SLE populations and patient preferences are needed.

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