Clinical practice guidelines for systemic lupus erythematosus: Recommendations for general clinical management

Trujillo‐Martín, María M.; Larrinoa, Iñigo Rúa-Figueroa Fernández de; Ruíz-Irastorza, Guillermo; Pego‐Reigosa, José María; Sánchez, Juan Manuel Espinosa; Serrano‐Aguilar, Pedro

doi:10.1016/j.medcle.2016.06.033

Cited by 10 publications

(14 citation statements)

References 133 publications

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“…A study has shown that rituximab can be an effective and well-tolerated therapeutic option for refractory lupus nephritis. 26 – 28 In MS, the immunosuppressants MMF, azathioprine, methotrexate and cyclophosphamide have been studied; however, their efficacy is not yet well established. A retrospective study has shown that 55% of patients had no evidence of disease activity when followed up with cyclophosphamide as induction therapy.…”

Section: Discussionmentioning

confidence: 99%

Coexistence of systemic lupus erythematosus and multiple sclerosis. A case report and literature review

Sánchez¹,

Castillo²,

González³

et al. 2018

Multiple Sclerosis Journal - Experimental, Translational and Cl

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Multiple sclerosis (MS) and systemic lupus erythematous (SLE) are autoimmune diseases, the coexistence of which is uncommon in patients. Owing to the rarity of this condition, the distinction between MS and SLE is a diagnostic challenge for neurologists. We present a case report in which MS and SLE were present in the same patient. There are few case reports in the world on the association between MS and SLE. The following case report is the first of its kind in which both MS and SLE are present in a patient from a country with low prevalence of MS such as Ecuador.

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Section: Discussionmentioning

confidence: 99%

Coexistence of systemic lupus erythematosus and multiple sclerosis. A case report and literature review

Sánchez¹,

Castillo²,

González³

et al. 2018

Multiple Sclerosis Journal - Experimental, Translational and Cl

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“…According to recommendations, MTP pulse was defined as the use of doses over 100 mg intravenously. 6,8,18,19 Inclusion criteria were set as follows: age over 15 years and having received pulse MTP therapy for an immune-mediated disease within the established period of time. Exclusion criteria were: having received pulse MTP therapy for diseases not immune-mediated (traumatic or tumor) and pregnancy.…”

Section: Methodsmentioning

confidence: 99%

Intravenous pulses of methylprednisolone to treat flares of immune-mediated diseases: how much, how long?

Danza

Borgia

Narváez

et al. 2018

Lupus

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Introduction Glucocorticoids are widely used in the treatment of immune-mediated diseases. Despite their widespread use, details on dosing, effectiveness and adverse effects are yet to be determined. Objective To know the current use of methylprednisolone (MTP) in the management of immune-mediated conditions, evaluating the relationship among doses, therapeutic response and adverse effects. Methodology A multicenter retrospective cohort study was designed, including patients who received intravenous pulses of MTP between 1 January 2013 and 12 December 2015 in three different hospitals in Uruguay. The patients included received MTP to treat systemic autoimmune diseases (SADs), hematological, nephrological and neurologic diseases and others. The following variables were analyzed: age, gender, MTP cumulative dose, duration of treatment, clinical response (complete, partial and no response) and adverse effects. Results In total, 164 cases were identified, of which 118 (72%) were female. The median age was 48.4 (SD: 18) years. The indications for MTP included: neuroimmune-mediated 92 (56.1%), SADs 29 (17.5%), hematological 15 (9.1%), nephrological 12 (7.3%) and others 16 (9.9%). The median dose to achieve complete response was 3.2 g (SD: 1.5); the median dose to accomplish a partial response was 3.5 g (SD: 1.25); the median dose for non-responders was 3.3 g (SD 1.2) ( p > 0.05). The median dose in those patients with adverse effects was 3.4 g (SD 1.5) and the median dose for those who did not experience adverse effects was 3.3 g (SD: 1.3) ( p > 0.05). The most frequent adverse effects were infectious (22/164, 13.4%). Diabetics were found to have the highest incidence of adverse effects (13/16, 81%) in comparison to non-diabetics, p < 0.05. Discussion Our study suggests a wide range of doses and duration of treatments with MTP. No major associations were found between clinical response and the use of high MTP doses, but the latter was associated with a large proportion of severe infections. No severe infections were identified with MTP doses lower than 1.5 g. The diabetic population is known to be at risk of experiencing varied adverse effects to MTP. These observations reinforce the need for protocolized use of MTP in order to achieve a better relationship among doses, effectiveness and safety profile.

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“…Glucocorticoid is recommended by international guidelines for the treatment of SLE. [12,13,15,53,56,57] For patients with SLE, individualized glucocorticoids therapy should be established according to disease activity, type and severity of organ involvement. The dosage should be adjusted according to disease activity, duration of medication use, and adverse reactions.…”

Section: Recommendation 12mentioning

confidence: 99%

“…When hydroxychloroquine or nonsteroidal anti-inflammatory medications could not adequately control the disease, low-dose glucocorticoids (prednisone ≤ 10 mg/day or equivalent) may be considered to help control disease activity. [12,13,15,53,56,57] For patients with moderate active SLE, moderate doses of prednisone (0.5 to 1 mg kg -1 d -1 ), or equivalent doses are recommended. In patients whose disease failed to under control by glucocorticoid alone, immunosuppressants may be used to reduce the cumulative dose of glucocorticoids and the risk of long-term adverse reactions.…”

Section: Recommendation 12mentioning

confidence: 99%

“…[15,56] In patients with severe SLE, pulse glucocorticoids therapy may be used if necessary. [12,53,57] Glucocorticoids pulse therapy combined with immunosuppressive agents are recommended for SLE patients with lupus crisis. Glucocorticoids pulse therapy is intravenous methylprednisolone 500-1,000 mg d -1 , usually over 3 consecutive days as a course of treatment.…”

Section: Recommendation 12mentioning

confidence: 99%

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2020 Chinese guidelines for the diagnosis and treatment of systemic lupus erythematosus

Zhao

Zhang

et al. 2020

Rheumatology and Immunology Research

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Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease that represents a prodigious challenge of diagnosis and treatment. In 2019, under the leadership of the Chinese Rheumatology Association, a multidisciplinary guideline development group was established to develop an evidence-based diagnosis and treatment guideline for patients with SLE in PR China. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence and the strength of recommendations. The guideline was reported following the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist. In this guideline, we provided recommendations for SLE classification criteria, disease activity monitoring and assessment, medication administration and considerations for SLE patients with organs and systems involved, and management of special populations such as SLE patients in the setting of pregnancy. This guideline serves as an evidence-based tool for Chinese clinicians to diagnose and treat patients with SLE.

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Clinical practice guidelines for systemic lupus erythematosus: Recommendations for general clinical management

Cited by 10 publications

References 133 publications

Coexistence of systemic lupus erythematosus and multiple sclerosis. A case report and literature review

Coexistence of systemic lupus erythematosus and multiple sclerosis. A case report and literature review

Intravenous pulses of methylprednisolone to treat flares of immune-mediated diseases: how much, how long?

2020 Chinese guidelines for the diagnosis and treatment of systemic lupus erythematosus

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