HHE Rheumatology 2019 | Page 10

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 HHE 2019 | hospitalhealthcare.com