2019 update of the EULAR recommendations for the management of systemic lupus erythematosus
Language English Country United States Media print-electronic
Document type Journal Article, Practice Guideline, Research Support, Non-U.S. Gov't
PubMed
30926722
DOI
10.1136/annrheumdis-2019-215089
PII: S0003-4967(24)00642-3
Knihovny.cz E-resources
- Keywords
- lupus nephritis, systemic lupus erythematosus, treatment,
- MeSH
- Biological Products therapeutic use MeSH
- Glucocorticoids therapeutic use MeSH
- Hydroxychloroquine therapeutic use MeSH
- Immunosuppressive Agents therapeutic use MeSH
- Comorbidity MeSH
- Humans MeSH
- Disease Management MeSH
- Evidence-Based Medicine methods MeSH
- Severity of Illness Index MeSH
- Lupus Erythematosus, Systemic complications drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Practice Guideline MeSH
- Names of Substances
- Biological Products MeSH
- Glucocorticoids MeSH
- Hydroxychloroquine MeSH
- Immunosuppressive Agents MeSH
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treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn.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.
Cliniques Universitaires Saint Luc Université catholique de Louvain Brussels Belgium
Cyprus League Against Rheumatism Aglantzia Cyprus
Department of Autoimmune Diseases Hospital Clinic Barcelona Spain
Department of Dermatology and Allergy University Hospital Bonn Bonn Germany
Department of Medicine Addenbrooke's Hospital Cambridge UK
Department of Nephrology G Gennimatas General Hospital Athens Greece
Department of Pathology Leiden University Medical Center Leiden Netherlands
Department of Rheumatology Aarhus University Hospital Aarhus Denmark
Division of Rheumatology Department of Medicine 3 Medical University of Vienna Vienna Austria
Nephrology Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
Rheumatology and Clinical Immunology Unit Attikon University Hospital Athens Greece
Rheumatology and Clinical Immunology University of Brescia Brescia Italy
Rheumatology Clinical Immunology and Allergy University Hospital of Heraklion Heraklion Greece
Rheumatology Unit Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
Rheumatology Unit Department of Medicine University of Padova Padova Italy
Rheumatology Unit Department of Medicine University of Perugia Perugia Italy
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