# Systemic lupus erythematosus: Auditing standard of care in Qatar

## TL;DR

This study evaluates how well a hospital in Qatar follows international guidelines for treating systemic lupus erythematosus, finding some areas needing improvement.

## Contribution

The paper provides a first-of-its-kind audit of SLE care standards in Qatar, highlighting adherence gaps and patient demographics.

## Key findings

- Hydroxychloroquine was initiated in all patients, but 11.5% discontinued it due to adverse effects.
- Ophthalmologic screening for retinopathy was documented in only 65% of patients.
- The patient cohort included 31% Qataris, higher than their population proportion in Qatar.

## Abstract

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with heterogeneous clinical presentations influenced by ethnicity, geography, and healthcare practices. This audit evaluated adherence to key quality indicators for SLE management at Hamad General Hospital (HGH), a major public tertiary care center in Doha, Qatar, in line with international standards.

A retrospective cross-sectional audit was conducted between March and July 2024 involving 61 patients with SLE attending the rheumatology clinic at HGH. This audit assessed adherence to four selected key quality indicators: hydroxychloroquine (HCQ) use, annual proteinuria screening, annual ophthalmologic screening for HCQ-related retinopathy, and medication reconciliation documentation during the most recent clinic visit.

All patients were initiated on HCQ, with 11.5% discontinuing it due to adverse effects. Annual proteinuria screening was completed in 95% of patients. Ophthalmologic screening for HCQ-related retinopathy was documented in 65%, and medication reconciliation was completed in 72% of cases. The cohort represented a total of 21 nationalities, including Qataris who accounted for 31%–a proportion higher than their estimated 11.6% representation in Qatar’s national population.

While adherence to HCQ initiation and renal monitoring met international benchmarks, ophthalmologic screening and medication reconciliation rates were suboptimal and required improvement. Targeted system-level and educational interventions are planned to enhance adherence to these standards. Re-audit following implementation will be essential to assess progress and to sustain the quality of care.