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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)*
  1. G K Bertsias (gbert{at}med.uoc.gr)
  1. Internal Medicine, and Rheumatology, Clinical Immunology and Allergy, University of Crete, Greece
    1. J P A Ioannidis
    1. Clinical Trials and Evidence-Based Medicine Unit, Department of Hygiene and Epidemiology, Greece
      1. J Boletis
      1. Department of Nephrology and Transplantation Medicine, Laiko Hospital, Athens, Greece
        1. S Bombardieri
        1. Cattedra di Reumatologia, Universita di Pisa, Pisa, Italy
          1. R Cervera
          1. Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
            1. C Dostal
            1. Institute of Rheumatology, Prague, Czech Republic
              1. J Font
              1. Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
                1. I M Gilboe
                1. Department of Rheumatology, Rikshospitalet, Oslo, Norway
                  1. F Houssiau
                  1. Rheumatology Department, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Belgium
                    1. T Huizinga
                    1. Department of Rheumatology Leiden University Medical Center, Leiden, Netherlands
                      1. D Isenberg
                      1. Centre for Rheumatology, University College London Hospitals, London, United Kingdom
                        1. C GM Kallenberg
                        1. Department of Clinical Immunology, University Medical Center Groningen, Groningen, Netherlands
                          1. M Khamashta
                          1. Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, London, United Kingdom
                            1. J C Piette
                            1. Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
                              1. M Schneider
                              1. Rheumatolology, Clinic of Endocrinology, Diabetology and Rheumatology, Heinrich-Heine-University, Germany
                                1. J Smolen
                                1. Department of Rheumatology, Medical University of Vienna, Austria
                                  1. G Sturfelt
                                  1. Department of Rheumatology, University Hospital of Lund, Lund, Sweden
                                    1. A Tincani
                                    1. Rheumatologia e Immunologia Clinica, Ospedale Civile di Brescia, Italy
                                      1. R van Vollenhoven
                                      1. Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Sweden
                                        1. C Gordon
                                        1. Centre for Immune Regulation, Division of Immunity and Infection, The University of Birmingham, United Kingdom
                                          1. D T Boumpas (boumpasd{at}med.uoc.gr)
                                          1. Internal Medicine, and Rheumatology, Clinical Immunology and Allergy, University of Crete, Greece

                                            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.

                                            • monitoring
                                            • morbidity
                                            • nephritis
                                            • neuropsychiatric lupus
                                            • prognosis

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                                            • Lay summary

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