October 2018, CANADIAN RHEUMATOLOGY ASSOCIATION IMPROVES OUTCOMES IN SLE
As an initiative of the Canadian Rheumatology Association and endorsed by Lupus Canada and the Canadian Network of Improved Outcomes in SLE, the Canadian SLE Working Group has recently published new recommendations for the assessment and monitoring of lupus patients in Canada. This working group includes 23 adult and 4 pediatric rheumatologists, 1 immunologist, 4 general internal medicine and rheumatology trainees, and 1 representative from the Canadian Arthritis Patient Alliance. These recommendations are meant to help lupus healthcare providers in the evaluation of their patients, and help identify how and what to assess over time. These are the first lupus recommendations internationally to use a method called GRADE (Grading of Recommendations, Assessment, Development and Evaluation). This method carefully looks at the evidence behind each recommendation, and considers how it benefits or harms the patient, what resources would be required and if it is something that can be delivered equally to patients across the country. The working group looks forward to considering future recommendations in lupus treatments as a next step.
These recommendations confirm things that we already knew – that patients need to ensure their lupus healthcare provider is performing a thorough assessment per visit. In some cases, patients might notice over time that the practitioner is using a score to quantify this, which they can compare over time. The recommendations also help remind everyone how important heart health and the annual flu shot is. The recommendations do suggest that cervical cancer screening (aka PAP smears) should be done more frequently (eg. annually) rather than every 3 years as is stated in the Canadian guidelines for the general population. Pregnancy is definitely highlighted in these recommendations, with a strong recommendation to ensure a special set of antibodies called anti-Ro and anti-La have been done to evaluate the risk for a rare but important problem called neonatal lupus, where babies can have a serious problem known as congenital heart block. Close monitoring of women during the pregnancy period with coordinated care between physicians including obstetricians, maternal-fetal-medicine and other specialists and the lupus healthcare provider are encouraged.