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glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn.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

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Affiliated Institutions

• Cliniques Universitaires Saint-Luc BE
• Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico IT
• UCLouvain BE
• University of Cyprus CY
• University Hospital Münster DE
• University of Padua IT
• University Hospital of Heraklion GR
• Leiden University Medical Center NL
• Aarhus University Hospital DK
• Amsterdam University Medical Centers NL
• General Hospital of Athens G. Genimatas GR
• Addenbrooke's Hospital GB
• Karolinska Institutet SE
• Rigshospitalet DK
• Heinrich Heine University Düsseldorf DE
• Pediatric Nephrology of Alabama US
• Metabolism and Renal Physiology FR
• Medical University of Vienna AT
• Brescia University US
• Karolinska University Hospital SE
• University Hospital Carl Gustav Carus DE
• University of Perugia IT
• Charles University CZ
• University Hospital Bonn DE
• University of Birmingham GB
• ENT and Allergy US
• University General Hospital Attikon GR
• Biomedical Research Foundation of the Academy of Athens GR
• University of Pisa IT
• University of Brescia IT
• Center for Rheumatology US
• National and Kapodistrian University of Athens GR
• Arcispedale Sant'Anna IT
• University of Ferrara IT

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