Optimizing Patient Care: A Systematic Review of Multidisciplinary Approaches for SLE Management

Abstract

Systemic lupus erythematosus (SLE) is characterized by multisystemic clinical manifestations ranging from a relatively mild involvement to potentially life-threatening complications. Due to this complexity, a multidisciplinary (MD) approach is the best strategy for optimizing patients' care. The main aim of this systematic literature review (SLR) was to scrutinize the published data regarding the MD approach for the management of SLE patients. The secondary objective was to evaluate the outcomes of the MD approach in SLE patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used. We performed an SLR to retrieve articles available in English or Italian listed in PubMed, Embase, Cinahl, and Cochrane Library concerning the MD approach used in observational studies and clinical trials. Four independent reviewers performed the study selection and data collection. Of 5451 abstracts evaluated, 19 studies were included in the SLR. The MD approach was most frequently described in the context of SLE pregnancy, reported in 10 papers. MD teams were composed of a rheumatologist, except for one cohort study; a gynecologist; a psychologist; a nurse; and other health professionals. MD approaches had a positive impact on pregnancy-related complications and disease flares and improved SLE psychological impact. Although international recommendations advise an MD approach for managing SLE, our review highlighted the paucity of data supporting this strategy, with most of the available evidence on the management of SLE during pregnancy.

Keywords: multidisciplinary approach; multidisciplinary team; systematic literature review; systemic lupus erythematous.

Figure 1

Literature retrieval strategy according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

Figure 2

Quality assessment tables of included studies. Review of authors’ judgements about each risk of bias using NIH risk of bias tool. Green box = “yes/low risk of bias”; yellow box = “not applicable/not reported”; red box = “no/potential risk of bias” [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27].

Figure 2

Quality assessment tables of included studies. Review of authors’ judgements about each risk of bias using NIH risk of bias tool. Green box = “yes/low risk of bias”; yellow box = “not applicable/not reported”; red box = “no/potential risk of bias” [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27].

Figure 3

Qualitative representation of the overall effect of the MD approach on SLE outcomes in the context of psychiatry (a), pregnancy (b), and other dimensions of the disease (c). Where the authors did not make a comparison with a control group, the effect of the interventions was considered null. (a) Effects of different psychological/psychiatric interventions on SLE disease activity, damage accrual, health-related quality of life, and patient-reported outcomes, compared with patients undergoing usual care. (b) In the context of SLE pregnancy, the comparison group consisted of other pregnant SLE patients (treated according to site-specific usual care procedures) or non-SLE pregnant women. If a comparator group was absent or the effect of MD was not significantly different from that of a usual care approach, the effect was considered null. (c) Three studies evaluated multidisciplinary experiences in the context of disease control and compliance to therapy [12], access to healthcare services [15,23], or attribution of a neuropsychiatric event to SLE [20].