• Stephanie O Keeling, Asvina Bissonauth, Sasha Bernatsky, Ben Vandermeer, Paul R Fortin, Dafna D Gladman, Christine Peschken, and Murray B Urowitz.
• From the Division of Rheumatology, University of Alberta, Edmonton, Alberta; Division of Rheumatology, McGill University, Montreal, Quebec; Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta; Division of Rheumatology, CHU de Québec, Université Laval, Quebec City, Quebec; Division of Rheumatology, University of Toronto, Toronto, Ontario; Division of Rheumatology, University of Manitoba, Winnipeg, Manitoba, Canada. Stephanie.keeling@ualberta.ca.
• J Rheumatol. 2018 Oct 1; 45 (10): 1440-1447.

ObjectiveTo evaluate the diagnosis, monitoring, and treatment of systemic lupus erythematosus (SLE) in Canada.MethodsA 63-question electronic survey was developed with the Canadian Rheumatology Association and others. Descriptive analyses of responses were performed.ResultsSurvey respondents (n = 175) reported varying practices in the diagnosis, monitoring, and treatment of SLE. Performance of laboratory investigations for diagnosis and monitoring varied, with 78% of responders performing them at least every 6 months. Validated measures of SLE disease activity and damage were not commonly used. Most common first-line agents besides steroids for induction therapy for class III or IV lupus nephritis included intravenous cyclophosphamide and mycophenolate mofetil. Antimalarial use was common, with 96% of respondents using these in active skin disease. Over 60% of respondents indicated that 80-100% of their patients were taking antimalarials, while another 25% indicated they used these drugs in up to 80% of their patients. There were 71% of responders who reported completing frequent (6-12 mos) ophthalmology screening in patients taking antimalarials. Biologics were infrequently used. Responders were more likely to stop azathioprine and chloroquine than hydroxychloroquine in pregnant patients with SLE. Other aspects of routine care including vaccination and cardiovascular risk management varied considerably. The majority (80%) agreed that a dedicated multidisciplinary care team would improve SLE care.ConclusionConsiderable practice variation in SLE management was noted. This may help inform future recommendations for the diagnosis, monitoring, and treatment of SLE in Canada.

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