Table 2.

Proposed Strategies to Manage an Infectious Challenge in Systemic Lupus (SLE)

Management of infection guidance	Increase awareness that fever in SLE is infectious until proven otherwise, where diagnostic tools must be applied to confirm infection diagnosis. Initiate antibiotic therapy promptly and reduce time to antibiotic therapy administration when an infection is suspected. Determine SLE disease activity and avoid overdiagnosis of lupus disease flare. Reduce exposure to glucocorticoids, cytotoxic immunosuppressive and immune suppressive therapy during concurrent antibiotics use. Continue hydroxychloroquine with its safety profile in all SLE patients without convincing contraindications and improve strategies to advance adherence.
Deliver person-centered and coordinated care	Apply multi-disciplinary approaches among rheumatologists, primary care providers, infectious disease experts, and other specialty teams caring for SLE patients to optimize screening (hepatitis, tuberculosis, etc), diagnostic practices, and management of infections in SLE.
Guidance for elective surgery	Perform elective procedures during inactive disease state. Balance the benefit of low-dose glucocorticoids with the potential risk of infection.
Improve patient safety through open and clear communication	Communicate with SLE patients clearly about the crucial role of hygiene, high risk exposure to infection and knowledge of febrile illness characteristics and signs and symptoms of infection.
Reduce the risk of contracting infections	Boost patient confidence in immunization to increase vaccination coverage rates and prevent leading infections in SLE that are vaccine preventable Review vaccination status at every healthcare encounter given vaccinations are substantially under-utilized in SLE.
Personalized patient education and engagement	Discuss treatment goals and preventive strategies related to SLE with patients, caregivers, and care partners at all times of the decision-making process.