2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

Antonis Fanouriakis, Myrto Kostopoulou, Alessia Alunno, Martin Aringer, Ingeborg Bajema, John N. Boletis, Ricard Cervera, Andrea Doria, Caroline Gordon, Marcello Govoni, Frédéric Houssiau, David Jayne, Marios Kouloumas, Annegret Kuhn, Janni L. Larsen, Kirsten Lerstrøm, Gabriella Moroni, Marta Mosca, Matthias Schneider, Josef S. SmolenElisabet Svenungsson, Vladimir Tesar, Angela Tincani, Anne Troldborg, Ronald Van Vollenhoven, Jörg Wenzel, George Bertsias, Dimitrios T. Boumpas

Research output: Contribution to journalArticle

Abstract

Our objective was to update the EULAR recommendations for the management of systemic lupus erythematosus (SLE), based on emerging new evidence. We performed a systematic literature review (01/2007-12/2017), followed by modified Delphi method, to form questions, elicit expert opinions and reach consensus. Treatment in SLE aims at remission or low disease activity and prevention of flares. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. During chronic maintenance treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn. Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can expedite the tapering/discontinuation of GC. In persistently active or flaring extrarenal disease, add-on belimumab should be considered; rituximab (RTX) may be considered in organ-threatening, refractory disease. Updated specific recommendations are also provided for cutaneous, neuropsychiatric, haematological and renal disease. Patients with SLE should be assessed for their antiphospholipid antibody status, infectious and cardiovascular diseases risk profile and preventative strategies be tailored accordingly. The updated recommendations provide physicians and patients with updated consensus guidance on the management of SLE, combining evidence-base and expert-opinion.

Original languageEnglish
Pages (from-to)736-745
JournalAnnals of the Rheumatic Diseases
Volume78
Issue number6
DOIs
Publication statusPublished - Jan 1 2019

Keywords

  • lupus nephritis
  • systemic lupus erythematosus
  • treatment

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

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    Fanouriakis, A., Kostopoulou, M., Alunno, A., Aringer, M., Bajema, I., Boletis, J. N., Cervera, R., Doria, A., Gordon, C., Govoni, M., Houssiau, F., Jayne, D., Kouloumas, M., Kuhn, A., Larsen, J. L., Lerstrøm, K., Moroni, G., Mosca, M., Schneider, M., ... Boumpas, D. T. (2019). 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Annals of the Rheumatic Diseases, 78(6), 736-745. https://doi.org/10.1136/annrheumdis-2019-215089