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

Keeling SO1,2Alabdurubalnabi Z3,4Avina-Zubieta A3,4Barr S3,4Bergeron L3,4Bernatsky S3,4Bourre-Tessier J3,4Clarke A3,4Baril-Dionne A3,4Dutz J3,4Ensworth S3,4Fifi-Mah A3,4Fortin PR3,4Gladman DD3,4Haaland D3,4Hanly JG3,4Hiraki LT3,4Hussein S3,4Legault K3,4Levy D3,4Lim L3,4Matsos M3,4McDonald EG3,4Medina-Rosas J3,4Pardo Pardi J3,4Peschken C3,4Pineau C3,4Pope J3,4Rader T3,4Reynolds J3,4Silverman E3,4Tselios K3,4Suitner M3,4Urowitz M3,4Touma Z3,4Vinet E3,4Santesso N3,4.

J Rheumatol. 2018 Oct;45(10):1426-1439. doi: 10.3899/jrheum.171459. Epub 2018 Sep 1.





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


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.


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.


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.