Lupus Checks That Are Easy to Miss Between Flares

Lupus care tends to focus on how you feel now. The routine checks below are easier to miss because several look for problems with no early symptoms, and one of them (the hydroxychloroquine eye screening) happens at a different office. Each one is listed with what the guideline says and which edition says it. It is a list of what to ask about, not advice about your treatment.

For a one-page lab summary to bring to the visit, see our page on a lupus lab results summary for your rheumatologist.

The routine checks and what the guidelines say

• Urine protein (kidney involvement). The American College of Rheumatology's 2024 lupus nephritis guideline strongly recommends screening for proteinuria at least every 6 to 12 months, or when someone has a flare outside the kidneys. For people with lupus nephritis, it says every 3 months until a complete response, then every 3 to 6 months. EULAR's 2023 recommendations say lupus activity should be assessed at each clinic visit, with regular screening for organ involvement, especially the kidneys.
• Complement (C3, C4) and anti-dsDNA. For people with lupus nephritis, the American College of Rheumatology's 2024 guideline says these should be checked at every clinic visit but not more often than monthly. EULAR's older 2010 monitoring recommendations say they may support evidence of disease activity or remission.
• Hydroxychloroquine eye screening. The American Academy of Ophthalmology revised its advice in 2025: a baseline exam soon after hydroxychloroquine is begun, then annual screening while using it, which may be deferred during the first 5 years if there are no significant risk factors. Its 2016 version named kidney disease and tamoxifen use as major risk factors. EULAR's 2023 recommendations give a target dose of 5 mg per kg of real body weight per day, which is for your prescriber to judge.
• Blood counts and routine urine tests. EULAR's 2010 monitoring recommendations say people with inactive disease should have a complete blood count, urinalysis and a urine protein-to-creatinine ratio at 6 to 12 month intervals.
• Heart risk and bone health. EULAR's 2023 recommendations say management of bone health, kidney protection and cardiovascular risk should be performed. Its 2010 recommendations say osteoporosis screening should include people on steroids.
• Vaccines. EULAR's 2023 recommendations list immunisations against shingles (herpes zoster), HPV, influenza, COVID-19 and pneumococcus. Ask your rheumatologist which ones fit with your treatment.

Questions to ask your rheumatologist

• How often should my urine be tested for protein, and when was the last test?
• Are my complement and anti-dsDNA levels on a regular schedule?
• Am I on schedule for hydroxychloroquine eye screening under the 2025 advice, and do I have any of the risk factors?
• Does my hydroxychloroquine dose fit the EULAR target for my weight?
• When was my last complete blood count?
• Should my bone health or heart risk be checked, especially if I take steroids?
• Which vaccines am I due for, and are any not suitable with my treatment?

For a first rheumatology visit, our checklist of what to bring to a first specialist appointment goes with this page.

A free check you can run with your AI assistant

If you use Claude or ChatGPT and have connected it to philongevity.com/mcp (the steps are on our page for AI assistants), ask it to run the Phi Longevity care-gaps check. It needs no lab values, dates, names or records: only your condition, a few types of medicine, and for each routine test whether it was done recently, overdue, never done, or you are not sure. It returns the same list as this page, in order, with the guideline behind each item, the questions to ask each clinician, and a one-page checklist to print. It is decision support for visit preparation, not a diagnosis.

What to do with the files

1. Download your lab reports from each place you have been seen (how to download lab results from MyChart).
2. Connect MyChart at participating Epic health systems, or upload the reports, in your own account at philongevity.com.
3. Phi Longevity PRISM builds a one-page Care Team Brief with each result, its date, its trend and the guideline behind each flag, so the dates of your last urine and blood tests are on one page. See the lupus lab guide.

Phi Longevity is not a healthcare provider or a "covered entity" under HIPAA for your personal account. We store your records in HIPAA-eligible systems under a signed business associate agreement with Google Cloud, and we protect them to that standard. You can ask us to delete your data at any time.

Your first Care Team Brief is free. Phi Longevity Complete is $19/month and keeps the brief current as new results arrive.

Start free: put my lupus results on one page →

What Phi Longevity PRISM does not do

It does not diagnose, and it does not tell you which tests you need, how often, or what a result means for you. The schedules on this page are the general ones the guidelines state; your clinician may set a different one. It reads lab results today; medicines, diagnoses and allergies are not imported yet. It uses the range printed on your own lab report and never swaps in its own. It does not tell you whether you are in a flare. Your rheumatologist decides what you need.