Table 3:

List of SLE-specific ambulatory care sensitive potentially preventable conditions reaching consensus and the strategy for prevention or reduction of adverse outcomes^*

SLE-Specific Ambulatory Care Sensitive Condition	Strategy for Prevention or Reduction of Adverse Outcomes
Vaccine-preventable illnesses
High-grade cervical dysplasia/cervical cancer	HPV vaccination and regular pap screening with HPV cotesting per 2018 American College of Obstetricians and Gynecologists, American Society for Colposcopy and Cervical Pathology and the Society of Gynecologic Oncology
Influenza	Yearly influenza vaccine
Herpes zoster	Live attenuated herpes zoster vaccine (Zostavax) and HZ/su adjuvanted herpes zoster subunit vaccine (Shingrix)
Meningococcal disease	Meningococcal vaccines (quadrivalent vaccine approved for ages 11–18, and for ages <10 and >19 who are at increased risk for invasive meningococcal disease, and serogroup B vaccine FDA approved for individuals 10–25, also supported for anyone >10 by the Advisory Committee on Immunization Practices)
Pneumococcal disease	Pneumococcal vaccines (PCV13 and PPSV23)
Hepatitis B (HBV)	HBV vaccination and screening for chronic infection or prior exposure (Hepatitis B core antibody and Hepatitis surface antigen) prior to initiation of immunosuppressive medications and consideration of antiviral treatment when indicated
Medication-related complications
Vision loss from hydroxychloroquine toxicity	Dose adjustment (<5mg/kg real weight) and baseline fundus exam and then after 5 years, yearly optical coherence tomography (OCT) plus automated visual field examinations per the American Academy of Ophthalmology
Opioid overdose	Opioid agonist therapy prescribing and overdose education and identification of high-risk patients for close monitoring
Chronic opioid use	Pain management alternatives for SLE patients and treatment of concomitant fibromyalgia diagnoses
Pneumocystis jirovecii pneumonia (PJP) on moderate to high doses of glucocorticoids+	PJP prophylaxis (trimethoprim-sulfamethoxazole, atovaquone, dapsone)
Gastrointestinal bleed on glucocorticoids, NSAIDs, or anticoagulants	Proton pump inhibitors
Complications from uncontrolled glucocorticoid-induced diabetes	Minimization of glucocorticoids, glucose monitoring and intervention when appropriate
Osteoporotic fracture on glucocorticoids	Following the American College of Rheumatology guidelines regarding osteoporosis screening, prevention and treatment depending on age and level of fracture risk
Avascular necrosis (osteonecrosis) on prolonged glucocorticoid therapy	Minimizing glucocorticoid use (e.g. early consideration of steroid-sparing agents), and early recognition of avascular necrosis as prognosis and potential for native joint preservation are affected by disease stage
Reproductive health-related complications
Fetal anomalies on teratogenic medications	Assessment of reproductive health preferences, offering appropriate, effective contraception or prescribing of pregnancy-compatible medications for women planning to conceive
Vascular thrombosis with estrogen-containing contraception and positive antiphospholipid antibodies	Avoiding estrogen-based contraception in the setting of antiphospholipid antibody positivity
Premature ovarian insufficiency/infertility following standard dose cyclophosphamide	Use of gonadotropin-releasing hormone analog
Spontaneous abortion while on teratogenic medications	Discussion about potential teratogenic risks and offering effective contraception
Obstetrical complications in SLE patients with antiphospholipid syndrome (APS)	Recognition of APS and appropriate treatment with low dose aspirin and prophylactic-dose low molecular weight heparin or unfractionated heparin, and consideration of hydroxychloroquine use
Neonatal lupus/congenital heart block with maternal anti-Ro/La antibodies	Appropriate testing for anti-Ro/La antibodies, hydroxychloroquine use, and fetal cardiac monitoring
SLE-related comorbidities
Vascular thrombosis in SLE patients with known APS	Anticoagulation with appropriate monitoring of INR. Consideration of hydroxychloroquine use.
Embolic stroke in SLE patients with known APS	APS management with anticoagulation with appropriate monitoring of INR, control of active SLE with prednisone and/or immunosuppressives as appropriate, and consideration of echocardiographic evaluation for valvular disease. Consideration of hydroxychloroquine use.
Lupus flare in the absence of ultraviolet (UV) protection	UV protection and sun avoidance counseling
Chronic kidney disease or end-stage renal disease (ESRD) in patients with known lupus nephritis	Renal biopsy to diagnose lupus nephritis, then monitoring of renal function, urinary protein, blood pressure and SLE disease activity labs per ACR guidelines and SLE quality indicators, as well as appropriate treatment for lupus nephritis (immunosuppressives, glucocorticoids, ACE inhibitor/ARB, hydroxychloroquine)
Recurrent myocardial infarction	Secondary prevention strategies (e.g. diet, weight loss, smoking cessation, exercise), aspirin, statin therapy, hypertension management and consideration of certain antihypertensives based on risk factors. If lupus anticoagulant positive, avoidance of oral contraceptives. Consideration of hydroxychloroquine use.

^*Please see Supplemental Data 2 for further details and for a review of preventability and importance data by condition and applicable references

⁺The expert panel concluded in their final recommendations that while PJP should be included in this list of potentially preventable conditions, the decision for use of prophylaxis should be made on a case-by-case basis weighing the population-based prevalence of the condition, the risks associated with the prophylactic antibiotics, the severity of the patient’s SLE, the patient’s comorbidities, and the concomitant use of other immunosuppressive agents.