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treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn.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 language | English |
|---|---|
| Pages (from-to) | 736-745 |
| Journal | Annals of the Rheumatic Diseases |
| Volume | 78 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jan 1 2019 |
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Keywords
- lupus nephritis
- systemic lupus erythematosus
- treatment
ASJC Scopus subject areas
- Rheumatology
- Immunology and Allergy
- Immunology
- Biochemistry, Genetics and Molecular Biology(all)
Cite this
2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. / Fanouriakis, Antonis; Kostopoulou, Myrto; Alunno, Alessia; Aringer, Martin; Bajema, Ingeborg; Boletis, John N.; Cervera, Ricard; Doria, Andrea; Gordon, Caroline; Govoni, Marcello; Houssiau, Frédéric; Jayne, David; Kouloumas, Marios; Kuhn, Annegret; Larsen, Janni L.; Lerstrøm, Kirsten; Moroni, Gabriella; Mosca, Marta; Schneider, Matthias; Smolen, Josef S.; Svenungsson, Elisabet; Tesar, Vladimir; Tincani, Angela; Troldborg, Anne; Van Vollenhoven, Ronald; Wenzel, Jörg; Bertsias, George; Boumpas, Dimitrios T.
In: Annals of the Rheumatic Diseases, Vol. 78, No. 6, 01.01.2019, p. 736-745.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus
AU - Fanouriakis, Antonis
AU - Kostopoulou, Myrto
AU - Alunno, Alessia
AU - Aringer, Martin
AU - Bajema, Ingeborg
AU - Boletis, John N.
AU - Cervera, Ricard
AU - Doria, Andrea
AU - Gordon, Caroline
AU - Govoni, Marcello
AU - Houssiau, Frédéric
AU - Jayne, David
AU - Kouloumas, Marios
AU - Kuhn, Annegret
AU - Larsen, Janni L.
AU - Lerstrøm, Kirsten
AU - Moroni, Gabriella
AU - Mosca, Marta
AU - Schneider, Matthias
AU - Smolen, Josef S.
AU - Svenungsson, Elisabet
AU - Tesar, Vladimir
AU - Tincani, Angela
AU - Troldborg, Anne
AU - Van Vollenhoven, Ronald
AU - Wenzel, Jörg
AU - Bertsias, George
AU - Boumpas, Dimitrios T.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
KW - lupus nephritis
KW - systemic lupus erythematosus
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=85063719926&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85063719926&partnerID=8YFLogxK
U2 - 10.1136/annrheumdis-2019-215089
DO - 10.1136/annrheumdis-2019-215089
M3 - Article
VL - 78
SP - 736
EP - 745
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
SN - 0003-4967
IS - 6
ER -