EULAR recommendations for the management of Systemic Lupus Erytematosus (SLE) Report of a Task Force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)*

G K Bertsias ¹, J P A Ioannidis ², J Boletis ³, S Bombardieri ⁴, R Cervera ⁵, C Dostal ⁶, J Font ⁵, I M Gilboe ⁷, F Houssiau ⁸, T Huizinga ⁹, D Isenberg ¹⁰, C GM Kallenberg ¹¹, M Khamashta ¹², J C Piette ¹³, M Schneider ¹⁴, J Smolen ¹⁵, G Sturfelt ¹⁶, A Tincani ¹⁷, R van Vollenhoven ¹⁸, C Gordon ¹⁹ and D T Boumpas ^1*

¹ Internal Medicine, and Rheumatology, Clinical Immunology and Allergy, University of Crete, Greece
² Clinical Trials and Evidence-Based Medicine Unit, Department of Hygiene and Epidemiology, Greece
³ Department of Nephrology and Transplantation Medicine, Laiko Hospital, Athens, Greece
⁴ Cattedra di Reumatologia, Universita di Pisa, Pisa, Italy
⁵ Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
⁶ Institute of Rheumatology, Prague, Czech Republic
⁷ Department of Rheumatology, Rikshospitalet, Oslo, Norway
⁸ Rheumatology Department, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Belgium
⁹ Department of Rheumatology Leiden University Medical Center, Leiden, Netherlands
¹⁰ Centre for Rheumatology, University College London Hospitals, London, United Kingdom
¹¹ Department of Clinical Immunology, University Medical Center Groningen, Groningen, Netherlands
¹² Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London, United Kingdom
¹³ Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
¹⁴ Rheumatolology, Clinic of Endocrinology, Diabetology and Rheumatology, Heinrich-Heine-University, Germany
¹⁵ Department of Rheumatology, Medical University of Vienna, Austria
¹⁶ Department of Rheumatology, University Hospital of Lund, Lund, Sweden
¹⁷ Rheumatologia e Immunologia Clinica, Ospedale Civile di Brescia, Italy
¹⁸ Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Sweden
¹⁹ Centre for Immune Regulation, Division of Immunity and Infection, The University of Birmingham, United Kingdom

^* To whom correspondence should be addressed. E-mail: boumpasd{at}med.uoc.gr.

Accepted 30 April 2007

Abstract

Objective: SLE is a complex disease with variable presentations, course and prognosis. We sought to develop evidenced-based recommendations addressing the major issues in the management of SLE.

Methods: The EULAR Task Force on SLE comprised 19 specialists and a clinical epidemiologist. Key questions for the management of SLE were compiled using the Delphi technique. A systematic search of PubMed and Cochrane Library Reports was performed using McMaster/Hedges clinical queries' strategies for questions related to the diagnosis, prognosis, monitoring, and treatment of SLE. For neuropsychiatric, pregnancy, and antiphospholipid syndrome questions, the search was conducted using an array of relevant terms. Evidence was categorized based on sample size and type of design and the categories of available evidence were identified for each recommendation. The strength of recommendation was assessed based on the category of available evidence and agreement on the statements was measured across the 19 specialists.

Results: Twelve questions were generated regarding the prognosis, diagnosis, monitoring, and treatment of SLE, including neuropsychiatric SLE, pregnancy, the antiphospholipid syndrome, and lupus nephritis. The evidence to support each proposition was evaluated and scored. After discussion and votes, the final recommendations were presented using brief statements. The average agreement among experts was 8.8 out of 10.

Conclusion: Recommendations for the management of SLE were developed using an evidence-based approach followed by expert consensus with high level of agreement among the experts.

Keywords: monitoring, morbidity, nephritis, neuropsychiatric lupus, prognosis

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Giannakopoulos, B., Krilis, S. A. (2009). How I treat the antiphospholipid syndrome. Blood 114: 2020-2030 [Abstract] [Full Text]  
• Ramos-Casals, M, Soto, M., Cuadrado, M., Khamashta, M. (2009). Rituximab in systemic lupus erythematosusA systematic review of off-label use in 188 cases. Lupus 18: 767-776 [Abstract]  
• Uppal, S., Hayat, S., Raghupathy, R (2009). Efficacy and safety of infliximab in active SLE: a pilot study. Lupus 18: 690-697 [Abstract]  
• Gordon, C, Jayne, D, Pusey, C, Adu, D, Amoura, Z, Aringer, M, Ballerin, J, Cervera, R, Calvo-Alen, J, Chizzolini, C, Dayer, J., Doria, A, Ferrario, F, Floege, J, Guillevin, L, Haubitz, M, Hiepe, F, Houssiau, F, Lesavre, P, Lightstone, L, Meroni, P., Meyer, O, Moulin, B, O'Reilly, K, Praga, M, Schulze-Koops, H, Sinico, R., Smith, K., Tincani, A, Vasconcelos, C, Hughes, G (2009). European consensus statement on the terminology used in the management of lupus glomerulonephritis. Lupus 18: 257-263 [Abstract]  
• Mecacci, F., Bianchi, B., Pieralli, A., Mangani, B., Moretti, A., Cioni, R., Giorgi, L., Mello, G., Matucci-Cerinic, M. (2009). Pregnancy outcome in systemic lupus erythematosus complicated by anti-phospholipid antibodies. Rheumatology (Oxford) 48: 246-249 [Abstract] [Full Text]  
• Day, C. J., Lipkin, G. W., Savage, C. O. S. (2009). Lupus nephritis and pregnancy in the 21st century. Nephrol Dial Transplant 24: 344-347 [Full Text]  
• Buyon, J P, Brucato, A, Friedman, D M (2008). What's in a name?. Ann Rheum Dis 67: 732-732 [Full Text]