Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Monitoring for patients with discoid lupus erythematosus (DLE) primarily involves assessing for complications related to the medications used for treatment NICE CKS.
- For patients on hydroxychloroquine:
- A baseline eye examination, including fundus photography and spectral domain optical coherence tomography, should be performed within 6–12 months of treatment initiation NICE CKS.
- Annual eye monitoring is recommended for all people who have taken hydroxychloroquine for greater than 5 years NICE CKS.
- Annual monitoring may be commenced before 5 years of treatment if additional risk factors for retinal toxicity exist, such as concomitant tamoxifen therapy, impaired renal function (estimated glomerular filtration rate less than 60 mL/minute/1.73 m2), or high-dose therapy (greater than 5 mg/kg/day of hydroxychloroquine sulfate) NICE CKS.
- For patients on other Disease-Modifying Anti-Rheumatic Drugs (DMARDs) such as azathioprine, leflunomide, methotrexate, mycophenolate mofetil, ciclosporin, or penicillamine:
- Full Blood Count (FBC), Renal function (creatinine/calculated GFR), and Liver Function Tests (LFTs: ALT and/or AST and albumin) are generally monitored every 2 weeks until the dose is stable for 6 weeks, then monthly for 3 months NICE CKS. Thereafter, monitoring is at least every 12 weeks NICE CKS.
- More frequent monitoring is required for people at higher risk of toxicity NICE CKS. If the dose is increased, monitoring should revert to every 2 weeks until the dose is stable for 6 weeks, then follow the previous schedule NICE CKS.
- For ciclosporin, blood glucose and blood pressure are also monitored with similar frequency NICE CKS.
- For leflunomide, blood pressure and weight are also monitored NICE CKS.
- If methotrexate is combined with leflunomide, monthly monitoring continues until stable for 12 months, then reduced frequency can be considered individually NICE CKS.
- For penicillamine, once stable for 12 months, monitoring can be considered for reduction to 3-monthly NICE CKS.
- For patients with chronic kidney disease (CKD):
- The frequency of eGFR monitoring should be tailored based on the underlying cause, the rate of decline in eGFR or increase in ACR, other risk factors (e.g., heart failure, diabetes, hypertension), changes in treatment, and intercurrent illness NICE NG203.
- Minimum eGFR monitoring frequency ranges from 0-1 checks per year for GFR categories G1/G2 with ACR category A1, up to 4 or more checks per year for GFR category G5 NICE NG203.