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

Annals of the rheumatic diseases, 2019-06, Vol.78 (6), p.736-745 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. ;2019 Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. ;ISSN: 0003-4967 ;ISSN: 1468-2060 ;EISSN: 1468-2060 ;DOI: 10.1136/annrheumdis-2019-215089 ;PMID: 30926722

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Title:
2019 update of the EULAR recommendations for the management of systemic lupus erythematosus
Author: 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
Subjects: Antiphospholipid antibodies ; Azathioprine ; Biological Products - therapeutic use ; Body weight ; Cardiovascular diseases ; Comorbidity ; Disease Management ; Disease prevention ; Evidence-Based Medicine - methods ; Glucocorticoids ; Glucocorticoids - therapeutic use ; Health risk assessment ; Humans ; Hydroxychloroquine ; Hydroxychloroquine - therapeutic use ; Immunomodulation ; Immunosuppressive Agents - therapeutic use ; Literature reviews ; Lupus ; Lupus Erythematosus, Systemic - complications ; Lupus Erythematosus, Systemic - drug therapy ; Management ; Medicin och hälsovetenskap ; Mental disorders ; Methotrexate ; Monoclonal antibodies ; Mycophenolic acid ; Prednisone ; Remission ; Risk factors ; Rituximab ; Severity of Illness Index ; Systemic lupus erythematosus
Is Part Of: Annals of the rheumatic diseases, 2019-06, Vol.78 (6), p.736-745
Description: 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.
Publisher: England: BMJ Publishing Group LTD
Language: English
Identifier: ISSN: 0003-4967
ISSN: 1468-2060
EISSN: 1468-2060
DOI: 10.1136/annrheumdis-2019-215089
PMID: 30926722
Source: MEDLINE
SWEPUB Freely available online
ProQuest Central

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

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