Although multiple national quality measures focus on the management and safety of rheumatoid arthritis, few measures address patients’ care with SLE. We applied a group of quality measures relevant to the care of SLE patients and used the ACR’s RISE registry to assess nationwide variations in care.

Data derived from RISE included patients with ≥two visits with SLE codes ≥30 days apart in 2017‐2018. We calculated performance on five quality measures: renal disease screening, blood pressure assessment and management; hydroxychloroquine (HCQ) prescribing; safe dosing for HCQ; and prolonged glucocorticoid use at doses > 7.5 mg/day. We reported performance on these measures at the practice level. We used logistic regression to assess independent predictors of performance after adjusting for sociodemographic and utilization factors.

We included 27,567 unique patients from 186 practices; 91.7% were female, 48% white, with a mean age of 53.5±15.2 years. Few patients had an adequate screening for the development of renal manifestations (39.5%). Although blood pressure assessment was common (94.4%), a significant fraction had untreated hypertension (17.7%). Many received HCQ (71.5%), but only 62% at doses ≤ 5.0 mg/kg/day. Some received at least moderate‐dose steroids for ≥ 90 days (18.5%). We observed significant practice variation on every measure.

We found potential gaps in care for patients with SLE across the U.S. Although differences in disease severity may explain some performance variation, dramatic differences suggest that developing quality measures to address SLE’s critical health care processes may improve care.