The Lupus Check 5 Tool: A Practical Approach to Initiating Treatment Reviews in Systemic Lupus Erythematosus

Although the treatment landscape for systemic lupus erythematosus (SLE) has evolved in recent years, there is still a significant unmet need and many patients do not achieve key treatment goals, such as remission and low disease activity. Failure to reach these goals increases the risk of flare, organ damage accrual, and mortality in patients with SLE, and can have a significant impact on patient quality of life (QOL). While the importance of monitoring patients with SLE is highlighted across treatment recommendations, there is no clinical guidance on how to identify patients at risk of disease exacerbation and when to effectively initiate treatment reviews to improve their clinical outcomes. To address this, a panel of lupus experts have developed a clinical decision aid named the Lupus Check 5 Tool, which aims to identify patients in need of a treatment review through a simple five-question checklist. These questions cover a range of topics, including persistent glucocorticoid use, ongoing disease activity despite therapy, monitoring changes in laboratory values, flare frequency and severity, and the incorporation of the patient perspective and shared decision-making into clinical practice. Herein, we provide a detailed overview of the tool questions and the clinical evidence supporting their use to identify patients at risk of disease worsening. Use of the Lupus Check 5 Tool during each patient visit could facilitate timely alteration of therapy to help reduce disease activity, improve QOL, and work toward the long-term goals of remission and low disease activity.