The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults

Abstract

Need for the guidelineDespite some improvement in survival data over the last 40 years (2;13), lupus patients still die on average 25 years earlier than the mean for women and men in the UK ( 16). The disease can present with slowly or rapidly progressive active disease at any age and can be associated with the rapid accumulation of damage if not promptly diagnosed, appropriately treated and regularly monitored (2;8;14;19;20). An up to date comprehensive guideline to optimise these aspects of management and consistent with current evidence and NHS practice, is warranted to improve the outcome of this variable and potentially life-threatening disease that causes considerable morbidity. There have been no previous UK based guidelines for lupus. The European (EULAR) recommendations for the management of lupus in general were not very detailed and were published in 2008( 22) although more specific recommendations were published for neuro-psychiatric lupus in 2010( 23) and joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ ERA-EDTA) recommendations for lupus nephritis were published in 2012( 24), as well as American College of Rheumatology (ACR) guidelines for the management of lupus nephritis in 2012(25). Objectives of the guidelineThe aim of this guideline was to produce recommendations for the management of adult lupus patients in the UK that cover the diagnosis, assessment, and monitoring of lupus and the treatment of mild, moderate and severe active lupus disease but that do not imply a legal obligation. The resulting recommendations are based on an extensive literature review up to June 2015 to produce evidence-based guidelines, particularly for the treatment of non-renal lupus, supplemented as necessary by expert opinion and consensus agreement (tables 1 and 2). The guideline development group recommend that patients with lupus nephritis are managed according to the EULAR/ERA-EDTA recommendations for lupus nephritis(24) and provide their levels of agreement with a summary of the most important items in those recommendations (table 3). Target population, target audience and stakeholder involvementThe guidelines address the management of adult patients only and have been developed by a multidisciplinary guideline development group set up by the BSR and led by CG, consisting of academic (CG, INB, DDC, MK, DI) and NHS consultants in rheumatology (MA, BG) and nephrology (DJ, LL), rheumatology trainees (MG, KS), a GP (BE) and a clinical nurse specialist (SB), a patient representative (YN) and a lay member (PN). All participants declared any conflicts of interest and these are listed at the end of this article. The target audience includes rheumatologists and other clinicians such as nephrologists, immunologists and dermatologists, trainees in these specialties and emergency medicine, GPs, clinical nurse specialists, and other allied health professionals involved in the care of adult lupus patients. Opinions of BSR SLE Full guideline final with...

Characterisation of Patients with Systemic Lupus Erythematosus in Malta: A Population Based Cohort Cross-Sectional Study

“…Antimalarials are strongly recommended in SLE to prevent flares and reduce the development of renal disease and chronic damage and for its steroid-sparing properties [23–28]. However, this study showed that only 60.7% of SLE patients were receiving hydroxychloroquine at the time of the study.…”

Kidneys and women's health: key challenges and considerations

“…Lupus affects eight times as many women as men 37 and the cheapest effective treatment for lupus nephritis, cyclophosphamide, can impair fertility if the dose is not minimized and the ovaries are not protected 38 . This risk deters women from accepting treatment.…”

Rituximab as Maintenance Treatment for Systemic Lupus Erythematosus: A Multicenter Observational Study of 147 Patients

“…The high rate of patients with musculoskeletal and skin involvement may be the reason for the relatively high proportion of patients with mild disease treated with RTX in our population (26%). This group, according to the guidelines of the British Society of Rheumatology , should not be treated with RTX. However, it should be noted that for patients with less severe disease, RTX was used in the context of reduced therapeutic options since in this population disease had previously failed to respond to a mean of ~3 immunosuppressive drugs.…”

“…Patients were stratified into the following 4 groups according to disease severity: mild, moderate, severe, and drug sparing. The first 3 groups were defined according to the British Society of Rheumatology guidelines . The group “drug sparing” included patients with mild or moderate disease to whom RTX was administered with the aim of sparing an ongoing immunosuppressive agent or avoiding an alternative immunosuppressant that was contraindicated in the patient.…”

“…Improving the management of the maintenance phase of SLE is therefore an unmet need , and newer therapeutic options are needed. RTX is frequently used in relapsing and refractory cases , and its use is supported by retrospective and prospective nonrandomized studies .…”