Background Systemic Lupus Erythematosus (SLE) is a risk factor for osteoporosis (OP) and ocular adverse drug reactions (OADR) as cataracts and secondary glaucoma, mainly owing to the chronic treatment with Glucocorticoids (GC). Recommendations and Quality Indicators (QIs) have been developed to guide rheumatologists in the monitoring and treating of these conditions [1, 2, 3, 4]. However it is well known how the adherence to Recommendations and QIs is low in clinical practice.
Objectives To evaluate if the introduction of a clinical chart developed for the routinary assessment of SLE patients, might improve the adherence of rheumatologists to the existing Recommendations for the monitoring of OP and ocular toxicity.
Methods In 2011 a core-set of clinical variables to be regularly evaluated in SLE patients was developed, based on Recommendations and QIs. Patients with a diagnosis of SLE based on the American College of Rheumatology criteria, followed at our Rheumatology Unit, were consecutively enrolled during their regular outpatient visit in 2012 and were evaluated using the SLE dedicated chart. Adherence to Recommendations and QIs was compared with data from the same patients before the introduction of the chart.
Results One hundred and eleven SLE patients were enrolled; 11 of them, with a follow-up (fu) shorter than 2 years were excluded. Therefore, 100 patients, 98 F/2 M, mean age 43,4±11,9 years, disease duration 17,4±7,8 years, mean fu 13,4±7 years, were analyzed. Before the introduction of the SLE-dedicated chart the prevalence of adherence to OP and ocular monitoring were respectively of 19 (19%) and 32 (32%) cases. After the use of the core-set these values changed respectively in 52 (52%) and 66 (66%) cases. The comparison of both these results showed a significant difference, with respective p values of 0,05 and 0,03.
Conclusions These results show how introducing an SLE ad hoc designed core-set might significantly increase the adherence to the OP and ocular monitoring in clinical practice, thus assuring an improvement in the quality of care of SLE patients.
Hoes JN, Jacobs JW, Boers M, Boumpas D, Buttgereit F, Caeyers N, et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2007 Dec; 66 (12): 1560-7
Yazdany J, Panopalis P, Zell Gillis J, Schmajuk G, MacLean CH, Wosfy D, et al. A quality indicator set for Systemic Lupus Erythematosus. Arthritis Rheum. 2009 Mar 15;61(3):370-7
Mosca M, Tani C, Aringer M, Bombardieri S, Boumpas D, Brey R, et al. European League Against Rheumatism recommandations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies. Ann Rheum Dis. 2010 Jul;69(7):1269-74
Mosca M, Tani C, Aringer M, Bombardieri S, Boumpas D, Cervera R et al. Development of quality indicators to evaluate the monitoring of SLE patients in routine clinical practice. Autoimmun Rev. 2011 May;10(7):383-8.
Disclosure of Interest None Declared