Ann Rheum Dis 69:1269-1274 doi:10.1136/ard.2009.117200
  • Recommendations

European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies

  1. L Carmona21
  1. 1Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy
  2. 2University Clinical Center Carl Gustav Carus at the Technical University of Dresden, Dresden, Germany
  3. 3University of Crete Medical School, Heraklion, Crete, Greece
  4. 4Department of Medicine/Neurology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
  5. 5Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
  6. 6Division of Rheumatology, University of Padova, Padova, Italy
  7. 7Renal Unit, Addenbrooke's Hospital, Cambridge, UK
  8. 8Lupus Research Unit, Rayne Institute, St Thomas Hospital, London, UK
  9. 9Department of Dermatology, University of Muenster, Muenster, Germany
  10. 10School of Immunity & Infection, University of Birmingham, Birmingham, UK
  11. 11Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  12. 12Department of Biochemistry, Institute of Medical Biology, Medical Faculty, University of Tromsø, Tromsø, Norway
  13. 13Rheumatology, Clinic of Endocrinology, Diabetology and Rheumatology, Heinrich-Heine-University, Duesseldorf, Germany
  14. 14Hospital Management, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
  15. 15Department of Medicine B and Center of Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  16. 16Department of Rheumatology, Medical University of Vienna, Austria
  17. 17UO Reumatologia e Immunologia Clinica, Spedali Civili e Università, Brescia, Italy
  18. 18The Karolinska Institute, Stockholm, Sweden
  19. 19Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, US Department of Health and Human Services, Bethesda, Maryland, USA
  20. 20University of Pennsylvania, Philadelphia, Pennsylvania, USA
  21. 21Research Unit, Sociedad Española de Reumatología, Madrid, Spain
  1. Correspondence to Dr Marta Mosca, University of Pisa, via Roma 67, Ospedale S. Chiara, Pisa, 56126, Italy; marta.mosca{at}
  • Accepted 19 October 2009
  • Published Online First 5 November 2009


Objectives To develop recommendations for monitoring patients with systemic lupus erythematosus (SLE) in clinical practice and observational studies and to develop a standardised core set of variables to monitor SLE.

Methods We followed the European League Against Rheumatism (EULAR) standardised procedures for guideline development. The following techniques were applied: nominal groups, Delphi surveys for prioritisation, small group discussion, systematic literature review and two Delphi rounds to obtain agreement. The panel included rheumatologists, internists, dermatologists, a nephrologist and an expert related to national research agencies. The level of evidence and grading of recommendations were determined according to the Levels of Evidence and Grades of Recommendations of the Oxford Centre for Evidence-Based Medicine.

Results A total of 10 recommendations have been developed, covering the following aspects: patient assessment, cardiovascular risk factors, other risk factors (osteoporosis, cancer), infection risk (screening, vaccination, monitoring), frequency of assessments, laboratory tests, mucocutaneous involvement, kidney monitoring, neuropsychological manifestations and ophthalmology assessment. A ‘core set’ of minimal variables for the assessment and monitoring of patients with SLE in clinical practice was developed that included some of the recommendations. In addition to the recommendations, indications for specific organ assessments that were viewed as part of good clinical practice were discussed and included in the flow chart.

Conclusions A set of recommendations for monitoring patients with SLE in routine clinical practice has been developed. The use of a standardised core set to monitor patients with SLE should facilitate clinical practice, as well as the quality control of care for patients with SLE, and the collection and comparison of data in observational studies.


  • Provenance and peer review Not commissioned; externally peer reviewed.