how to monitor SLE in routine clinical practice

SLE(systematic lupus erythmatosus) is a multisystem autoimmune rheumatic disease. The clinical manifestations of the disease are diverse, often complex, and results from inflammation in a variety of organs. Patients may present to a variety of specialists owing to the variable clinical and serological expression of disease.
Laboratory measures can be used to assess disease activity and damage. We recommend that the following procedures should be performed at each clinic visit.
Full blood count(FBC) and white cell differential to assess anaemia, neutropenia, leucopenia, lymphopenia, and thrombocytopenia. It is important to remember that haematological abnormalities maybe due to concomitant drug treatment, in particular, with cyclophosphamide, which lowers the white blood cell count, and azathioprine, which often increases the mean corpuscular volume but rarely causes a pancytopenia.
Erythrocyte sedimentation rate(ESR) paired with C reactive protein may help to distinguish lupus flare from infection, in which one would expect a raised ESR and CRP in the latter. However, sometimes, CRP maybe raised in patients with intercurrent infections, serositis, or erosive arthritis.
Urea ans serum creatinine, although these tests are often normal. A rapid rising urea and/or creatinine implies that renal activity is 'turning into' damage.
Liver function tests are mandatory in patients receiving particular disease modifying antirheumatic drugs. They may be deranged secondary to non-steroidal and anti-inflammatory drugs or autoimmune liver disease.
Urine analysis for red and white cells, protein, and cellular casts are useful tests of renal activity and may reveal clinical silent renal disease. If any of these analysis are abnormal and especially if serial tests are increasingly abnormal further investigations including a 24 hours urinary protein estimation or the often preferred protein/creatinine ratio estimation, and , and creatinine clearance rate should be taken together with a renal ultrasound.
Antinuclear antibodies(ANA) are positive in more than 95% of patients with lupus. Anti-double stranded DNA(dsDNA) antibodies are positive in about 60% of these patients and can be detected by immunofluorescent crithidia testing, ELISA, or radioimmunoassay. Antibodies to dsDNA may fluctuate with disease activity in many patients, but not in all.
Other routinely available autoantibodies have not been demonstrated to be helpful as markers of lupus activity. They may, however, be associated with lupus subsets. Anti-Roantibodies, for example, are linked to photosensitivity, subacute cutaneous lupus, and the neonatal lupus syndrome. Anti-La antibodies are associated with concomitant Sjogren's syndrome. Antiphospholipid antibodies often correlate with an increased risk of thrombosis, spontaneous miscarriage, or livedo reticularis. These antibodies are identified in the form of anticardiolipin antibodies, a positive 'so-called' lupus anticoagulant test, or anti-β2-glycoprotein I antibodies.