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, J. rg
AU - Bertsias, George
AU - Boumpas, Dimitrios T.
N1 - Funding Information: 13Cyprus League Against Rheumatism, Aglantzia, Cyprus 14University Hospital Muenster, Muenster, Germany 15Copenhagen Lupus and Vasculitis Clinic, Rheumatology and Spine Diseases Centre, Rigshospitalet, Copenhagen, Copenhagen, Denmark 16Lupus Europe, Farum, Denmark 17Nephrology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy 18Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy 19Department of Rheumatology & Hiller Research Unit Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany 20Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria 21Department of Medicine, Rheumatology Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden 22Department of Nephrology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic 23Rheumatology and Clinical Immunology, University of Brescia, Brescia, Italy 24Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark 25Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centers, Amsterdam, Netherlands 26Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany 27Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece 28Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece 29Joint Academic Rheumatology Program, Medical School, National and Kapodestrian University of Athens, Athens, Greece and Medical School, University of Cyprus, Nicosia, Cyprus Acknowledgements The committee wishes to acknowledge the support of the EULAR Standing Committee on Clinical Affairs. The committee also expresses its sincere appreciation and gratitude to the EULAR Secretariat and especially to Patrizia Jud, executive assistant, for the outstanding organisation. Funding Information: Funding AF was supported by an Articulum Fellowship and a grant from the Hellenic Society of Rheumatology during the completion of this work. Publisher Copyright: © 2019 Author(s). Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/6/1
Y1 - 2019/6/1
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 - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85063719926&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30926722
U2 - https://doi.org/10.1136/annrheumdis-2019-215089
DO - https://doi.org/10.1136/annrheumdis-2019-215089
M3 - Review article
C2 - 30926722
SN - 0003-4967
VL - 78
SP - 736
EP - 745
JO - Annals of the rheumatic diseases
JF - Annals of the rheumatic diseases
IS - 6
ER -