Effective monitoring of disease activity and treatment response in patients with systemic lupus erythematosus (SLE) in a primary care setting involves regular clinical assessment, patient education, and coordination with specialist care. Primary care clinicians should ensure patients have rapid access to specialist rheumatology services for flares or worsening symptoms, and provide information on when and how to seek this care. Regular review appointments should assess disease activity, treatment side effects, and comorbidities, with a focus on maintaining treatment targets such as remission or low disease activity. Functional ability and quality of life should also be evaluated to guide management decisions. Blood tests and clinical markers can support monitoring but should not delay specialist referral. Emerging therapies and biomarkers from recent trials (e.g., baricitinib and cenerimod) highlight the evolving landscape of treatment response assessment, but their use and monitoring protocols remain primarily within specialist settings. Therefore, primary care’s role centers on vigilant symptom monitoring, adherence support, and timely referral to specialists for comprehensive disease activity evaluation and treatment adjustment.
Key actions in primary care include:
- Providing patient education on disease symptoms and flare recognition to enable prompt reporting.
- Scheduling regular reviews to assess symptoms, functional status, and treatment side effects.
- Monitoring for comorbidities commonly associated with SLE, such as cardiovascular risk factors and osteoporosis.
- Ensuring rapid referral pathways to rheumatology for disease flares or inadequate treatment response.
- Supporting medication adherence and addressing psychosocial needs.
This approach aligns with the principles of chronic disease management in primary care and complements specialist-led monitoring that may include advanced biomarkers and imaging.
NICE NG100 Arnaud et al. 2011 Morand et al. 2023 Askanase et al. 2025
Key References
- NG100 - Rheumatoid arthritis in adults: management
- NG130 - Ulcerative colitis: management
- (Arnaud et al., 2011): The importance of assessing medication exposure to the definition of refractory disease in systemic lupus erythematosus.
- (Morand et al., 2023): Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 3 trial (SLE-BRAVE-I).
- (Askanase et al., 2025): Cenerimod, a sphingosine-1-phosphate receptor modulator, versus placebo in patients with moderate-to-severe systemic lupus erythematosus (CARE): an international, double-blind, randomised, placebo-controlled, phase 2 trial.