Τίτλος:
2019 Update of the EULAR recommendations for the management of systemic lupus erythematosus
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn.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 Author(s).
Συγγραφείς:
Fanouriakis, A.
Kostopoulou, M.
Alunno, A.
Aringer, M.
Bajema, I.
Boletis, J.N.
Cervera, R.
Doria, A.
Gordon, C.
Govoni, M.
Houssiau, F.
Jayne, D.
Kouloumas, M.
Kuhn, A.
Larsen, J.L.
Lerstrøm, K.
Moroni, G.
Mosca, M.
Schneider, M.
Smolen, J.S.
Svenungsson, E.
Tesar, V.
Tincani, A.
Troldborg, A.
Van Vollenhoven, R.
Wenzel, J.
Bertsias, G.
Boumpas, D.T.
Περιοδικό:
Annals of the Rheumatic Diseases
Εκδότης:
BMJ Publishing Group
Λέξεις-κλειδιά:
acetylsalicylic acid; azathioprine; belimumab; cyclophosphamide; dapsone; hydroxychloroquine; mepacrine; methotrexate; methylprednisolone; mycophenolate mofetil; mycophenolic acid; phospholipid antibody; prednisone; rituximab; thalidomide; biological product; glucocorticoid; hydroxychloroquine; immunosuppressive agent, body weight; cardiovascular risk; clinical protocol; disease activity; evidence based practice; human; immunomodulation; meta analysis; patient assessment; physician; priority journal; remission; Review; systematic review; systemic lupus erythematosus; thrombocytopenia; thrombosis; treatment outcome; comorbidity; complication; disease management; evidence based medicine; practice guideline; procedures; severity of illness index; systemic lupus erythematosus, Biological Products; Comorbidity; Disease Management; Evidence-Based Medicine; Glucocorticoids; Humans; Hydroxychloroquine; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Severity of Illness Index
DOI:
10.1136/annrheumdis-2019-215089
