BSR guideline on the management of adults with systemic lupus erythematosus (SLE) 2018: baseline multi-centre audit in the UK

Research output: Contribution to journalArticlepeer-review


  • Fiona A Pearce
  • Megan Rutter
  • Ravinder Sandhu
  • Rebecca L Batten
  • Rozeena Garner
  • Jayne Little
  • Nehal Narayan
  • Charlotte A Sharp
  • Ian N Bruce
  • Nicola Erb
  • Bridget Griffiths
  • Hannah Guest
  • Elizabeth Macphie
  • Jon Packham
  • Chris Hiley
  • Karen Obrenovic
  • Ali Rivett
  • Peter C Lanyon

Colleges, School and Institutes

External organisations

  • Nottingham University Hospitals NHS Trust
  • Department of Rheumatology, Russells Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust
  • Newcastle upon Tyne Hospitals NHS Foundation Trust
  • University of Manchester
  • University Hospital Birmingham
  • Manchester University Hospitals NHS Foundation Trust
  • Freeman Hospital, Newcastle upon Tyne.
  • Rheumatology, Lancashire and South Cumbria NHS Foundation Trust, Preston
  • Rheumatology, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent
  • British Society for Rheumatology
  • Clinical Audit Department, Dudley Group of Hospitals NHS Foundation Trust, Dudley


Objectives: To assess the baseline care provided to patients with SLE attending UK Rheumatology units, audited against standards derived from the recently published BSR guideline for the management of adults with SLE, the NICE Technology Appraisal for Belimumab, and NHS England’s Clinical Commissioning Policy for Rituxi-mab.

Methods: SLE cases attending outpatient clinics during any 4-week period between February–June 2018 were retro-spectively audited to assess care at the preceding visit. The effect of clinical environment (general vs. dedi-cated CTD/vasculitis clinic and specialised vs. non-specialised centre) were tested. Bonferroni’s correction was applied to the significance level.

Results: 51 units participated. We audited 1021 episodes of care in 1003 patients (median age 48 years, 74% diag-nosed >5 years ago). Despite this disease duration, 286 (28.5%) patients had active disease. Overall 497 (49%) were receiving prednisolone, including 28.5% of patients who had inactive disease. Low documented compliance (<60% clinic visits) was identified for audit standards relating to formal disease-activity assess-ment, reduction of drug-related toxicity and protection against comorbidities and damage. Compared to general clinics, dedicated clinics had higher compliance with standards for appropriate urine protein quantifi-cation (85.1% vs 78.1%, p =< 0.001). Specialised centres had higher compliance with BILAG-BR recruit-ment (89.4% vs 44.4%, p =< 0.001) and blood pressure recording (95.3% vs 84.1%).

Conclusions: This audit highlights significant unmet need for better disease control, reduction in corticosteroid toxicity and is an opportunity to improve compliance with national guidelines. Higher performance with nephritis screen-ing in dedicated clinics supports wider adoption of this service-delivery model.


Original languageEnglish
Early online date8 Dec 2020
Publication statusE-pub ahead of print - 8 Dec 2020


  • Systemic lupus erythematosus, Audit, standards of care, health services research