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

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treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn.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.

2019 Update of the Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA–EDTA) recommendations for the management of lupus nephritis

“…Recent insights in LN necessitated an update of the EULAR-ERA/ EDTA recommendations, which were developed by a large group of physicians from different specialties and nurses caring for LN, with input from patients, and complement the recently updated recommendations for SLE. 32 Inclusion of all involved medical disciplines is an advantage and accords to the multidisciplinary care that these patients need. These recommendations intend to inform rheumatologists, nephrologists, patients, national professional societies, hospital officials, social security agencies and regulators about the treatment of LN based on most recent evidence, to ensure optimal outcomes with existing therapies.…”

“…Since SLE is a systemic disease, immunosuppressive therapy should also target remission or low disease activity from extra-renal domains. 32…”

The anti-viral facet of anti-rheumatic drugs: Lessons from COVID-19

“…Glucocorticoids (GCs) are among the most frequently used agent in rheumatologic clinical practice. The GCs have proved to be effective in the management of a broad spectrum of diseases such as RA, systemic lupus erythematosus (SLE), vasculitis both representing the main treatment or a bridging/supporting therapy to the immunosuppressant [17][18][19][20].…”

Hydroxychloroquine: A Potential Ethical Dilemma for Rheumatologists during the COVID-19 Pandemic

“…In a first discontinuation study, the Canadian Hydroxychloroquine risk of having a disease flare 12 . This small pivotal study of 47 patients with stable SLE has promoted the current treatment practice, supported by guidelines worldwide, to maintain patients with SLE on HCQ indefinitely, even if disease severity requires introduction of more vigorous immunosuppressive treatments 13,14,15 . HCQ has proved invaluable in the management of skin manifestations of SLE as well as other immunological-related skin disorders 16 .…”