day). In patients with SLE aged >40 years, who
have a moderate to high risk of a major
osteoporotic (>10%) or hip fracture (>1%) within
10 years (as assessed by the fracture risk
assessment tool), antiresorptive therapy is
recommended if there are no contraindications.
Family planning
Clinicians involved in the care of SLE patients
should frequently discuss the topic of family
planning with all patients of childbearing age.
Family planning and contraception should be a
topic of discussion from the early phases of the
disease.
In the past, SLE was considered to be an
absolute contraindication to pregnancy, but
maternal and foetal outcomes in these women
have greatly improved thanks to a correct timing
of pregnancy, close monitoring, multidisciplinary
management and an increased knowledge about
the medications that can be used during
pregnancy and breastfeeding. 29,30
TABLE 5
Systemic Lupus International Collaborating Clinics/American College
of Rheumatology (SLICC/ACR) Damage Index
The frequency
of the follow-
up visits should
be based on
the activity
and severity of
the disease, its
complications
and evolution
Item Score
Ocular (either eye, by clinical assessment)
Any cataract ever
0,1
Retinal change or optic atrophy
0,1
Neuropsychiatric
Cognitive impairment (for example, memory deficit, difficulty with calculation, poor concentration,
difficulty in spoken or written language, impaired performance level) or major psychosis
0,1
Seizures requiring therapy for 6 months
0,1
0,1,2
Cerebrovascular accident ever (score 2 if >1)
0,1
Cranial or peripheral neuropathy (excluding optic)
Transverse myelitis
0,1
Renal
Estimated or measured glomerular filtration rate < 50%
0,1
0,1
Proteinuria >3.5g/24h
or end-stage renal disease (regardless of dialysis or transplantation)
or 3
Pulmonary
Pulmonary hypertension (right ventricular prominence, or loud P2)
0,1
0,1
Pulmonary fibrosis (physical and radiograph)
Pulmonary fibrosis (physical and radiograph)
0,1
0,1
Shrinking lung (radiograph)
Pleural fibrosis (radiograph)
0,1
0,1
Pulmonary infarction (radiograph)
Cardiovascular
0,1
Angina or coronary artery bypass
Myocardial infarction ever (score 2 if > 1)
0,1,2
0,1
Cardiomyopathy (ventricular dysfunction)
Valvular disease (diastolic murmur or systolic murmur >3/6)
0,1
Pericarditis for 6 months, or pericardectomy
0,1
Peripheral vascular
Claudication for 6 months
0,1
0,1
Minor tissue loss (pulp space)
Significant tissue loss ever (for example, loss of digit or limb)(score 2 if > 1 site)
0,1,2
0,1
Venous thrombosis with swelling, ulceration, or venous stasis
Gastrointestinal
Infarction or resection of bowel below duodenum, spleen, liver or gallbladder, for any
0,1,2
cause (score 2 if >1 site)
0,1
0,1
Mesenteric insufficiency
Chronic peritonitis
0,1
Musculoskeletal
Muscle atrophy or weakness
0,1
0,1
Deforming or erosive arthritis (including reducible deformities, excluding avascular necrosis)
Osteoporosis with fracture or vertebral collapse (excluding avascular necrosis)
0,1
0,1,2
Avascular necrosis (score 2 if >1)
Osteomyelitis 0,1
Tendon rupture
0,1
Skin
Scarring chronic alopecia
0,1
Extensive scarring of panniculum other than scalp and pulp space
0,1
0,1
Skin ulceration (excluding thrombosis for >6 months)
Premature gonadal failure
0,1
0,1
Diabetes (regardless of treatment)
Malignancy (exclude dysplasia) (score 2 if >1 site)
0,1,2
10
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