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First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)–Pan-American League of Associations of Rheumatology (PANLAR)
  1. Bernardo A Pons-Estel1,
  2. Eloisa Bonfa2,
  3. Enrique R Soriano3,
  4. Mario H Cardiel4,
  5. Ariel Izcovich5,
  6. Federico Popoff5,
  7. Juan M Criniti5,
  8. Gloria Vásquez6,
  9. Loreto Massardo7,
  10. Margarita Duarte8,
  11. Leonor A Barile-Fabris9,
  12. Mercedes A García10,
  13. Mary-Carmen Amigo11,
  14. Graciela Espada12,
  15. Luis J Catoggio3,
  16. Emilia Inoue Sato13,
  17. Roger A Levy14,
  18. Eduardo M Acevedo Vásquez15,
  19. Rosa Chacón-Díaz16,
  20. Claudio M Galarza-Maldonado17,
  21. Antonio J Iglesias Gamarra18,
  22. José Fernando Molina19,
  23. Oscar Neira20,
  24. Clóvis A Silva21,
  25. Andrea Vargas Peña22,
  26. José A Gómez-Puerta23,
  27. Marina Scolnik3,
  28. Guillermo J Pons-Estel1,24,
  29. Michelle R Ugolini-Lopes2,
  30. Verónica Savio25,
  31. Cristina Drenkard26,
  32. Alejandro J Alvarellos27,
  33. Manuel F Ugarte-Gil28,29,
  34. Alejandra Babini25,
  35. André Cavalcanti30,
  36. Fernanda Athayde Cardoso Linhares22,
  37. Maria Jezabel Haye Salinas27,
  38. Yurilis J Fuentes-Silva31,
  39. Ana Carolina Montandon de Oliveira e Silva32,
  40. Ruth M Eraso Garnica33,
  41. Sebastián Herrera Uribe34,
  42. Diana Gómez-Martín35,
  43. Ricardo Robaina Sevrini36,
  44. Rosana M Quintana1,24,
  45. Sergio Gordon37,
  46. Hilda Fragoso-Loyo35,
  47. Violeta Rosario38,
  48. Verónica Saurit27,
  49. Simone Appenzeller39,
  50. Edgard Torres dos Reis Neto13,
  51. Jorge Cieza40,
  52. Luis A González Naranjo6,
  53. Yelitza C González Bello41,
  54. María Victoria Collado42,
  55. Judith Sarano42,
  56. Soledad Retamozo27,
  57. María E Sattler43,
  58. Rocio V Gamboa-Cárdenas28,
  59. Ernesto Cairoli36,
  60. Silvana M Conti24,
  61. Luis M Amezcua-Guerra44,
  62. Luis H Silveira45,
  63. Eduardo F Borba2,
  64. Mariana A Pera10,
  65. Paula B Alba Moreyra46,
  66. Valeria Arturi10,
  67. Guillermo A Berbotto43,
  68. Cristian Gerling37,
  69. Carla A Gobbi46,
  70. Viviana L Gervasoni24,
  71. Hugo R Scherbarth37,
  72. João C Tavares Brenol47,
  73. Fernando Cavalcanti30,
  74. Lilian T Lavras Costallat39,
  75. Nilzio A Da Silva32,
  76. Odirlei A Monticielo47,
  77. Luciana Parente Costa Seguro2,
  78. Ricardo M Xavier47,
  79. Carolina Llanos48,
  80. Rubén A Montúfar Guardado49,
  81. Ignacio Garcia de la Torre50,
  82. Carlos Pineda51,
  83. Margarita Portela Hernández52,
  84. Alvaro Danza53,
  85. Marlene Guibert-Toledano54,
  86. Gil Llerena Reyes54,
  87. Maria Isabel Acosta Colman8,
  88. Alicia M Aquino8,
  89. Claudia S Mora-Trujillo40,
  90. Roberto Muñoz-Louis38,
  91. Ignacio García Valladares41,
  92. María Celeste Orozco55,
  93. Paula I Burgos48,
  94. Graciela V Betancur55,
  95. Graciela S Alarcón56,57
  96. on behalf of the Grupo Latino Americano de Estudio del Lupus (GLADEL) and Pan-American League of Associations of Rheumatology (PANLAR)
  1. 1 Departamento de Medicina Interna, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
  2. 2 Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
  3. 3 Sección de Reumatología, Servicio de Clínica Médica, Instituto Universitario, Escuela de Medicina, and Fundación Dr Pedro M Catoggio para el Progreso de la Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  4. 4 Centro de Investigación Clínica de Morelia, SC, Morelia, México
  5. 5 Servicio de Clínica Médica del Hospital Alemán de Buenos Aires, Hospital Alemán de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
  6. 6 Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Hospital Universitario, Fundación San Vicente, Medellín, Colombia
  7. 7 Centro de Biología Celular y Biomedicina, Facultad de Medicina y Ciencia. Universidad San Sebastián, Santiago, Chile
  8. 8 Departamento de Reumatología, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
  9. 9 Hospital Angeles del Pedregal, Ciudad de México, México
  10. 10 Servicio de Reumatología, HIGA General San Martín, La Plata, Argentina
  11. 11 Servicio de Reumatología, Centro Médico ABC, Ciudad de México, México
  12. 12 Servicio de Reumatología Infantil, Hospital de Niños Dr Ricardo Gutiérrez, Buenos Aires, Argentina
  13. 13 Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paul, Brazil
  14. 14 Discipline of Rheumatology, University of the State of Rio de Janeiro, Rio de Janeiro, Brasil
  15. 15 Facultad de Medicina., Universidad Nacional Mayor de San Marcos. Servicio de Reumatología. Clínica San Felipe, J. María., Lima, Perú.
  16. 16 Servicio de Reumatología, Policlínica Méndez Gimón, Caracas, Venezuela
  17. 17 Unidad de Enfermedades Reumáticas y Autoinmunes (UNERA), Corporación Médica Monte Sinaí., Cuenca, Ecuador
  18. 18 Universidad Nacional de Colombia, Bogotá, Colombia
  19. 19 Centro Integral de Reumatología, Reumalab, Medellín, Colombia
  20. 20 Sección de Reumatología, Hospital del Salvador. Universidad de Chile. Unidad de Reumatología. Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo., Santiago, Chile
  21. 21 Pediatric Department, Faculdade de Medicina, Children’s Institute, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
  22. 22 Clínica Reumatológica, Universidad de la República, and Unidad Docente Asistencial, Hospital Pasteur, Instituto Nacional de Reumatología., Montevideo, Uruguay
  23. 23 Servicio de Reumatología, Hospital Clinic, Barcelona, Spain
  24. 24 Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
  25. 25 Servicio de Reumatología, Hospital Italiano de Córdoba, Córdoba, Argentina
  26. 26 Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
  27. 27 Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
  28. 28 Servicio de Reumatología, Hospital General Guillermo Almenara Irigoyen, EsSalud., Lima, Perú
  29. 29 Universidad Científica del Sur, Lima, Perú
  30. 30 Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), Recife, Brazil
  31. 31 Unidad de Reumatología, Departamento de Medicina, Universidad de Oriente, Complejo Hospitalario Universitario Ruiz y Páez, Ciudad Bolívar, Venezuela
  32. 32 Serviço de Reumatologia, Departamento de Clinica Medica, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil
  33. 33 Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Hospital Pablo Tobón Uribe, Medellín, Colombia
  34. 34 Servicio de Reumatología, Hospital General de Medellín ‘Luz Castro de Gutierrez’ ESE, ARTMEDICA, Medellín, Colombia
  35. 35 Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Ciudad de México, Mexico
  36. 36 Unidad de Enfermedades Autoinmunes Sistémicas, Facultad de Medicina, Clínica Médica ‘C’, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
  37. 37 Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas, HIGA Dr Oscar Alende, Mar del Plata, Argentina
  38. 38 Servicio de Reumatología, Enfermedades Reumatológicas e Investigación Clínica (ERIC), Hospital Docente Padre Billini, Santo Domingo, Dominican Republic
  39. 39 Departamento de Clínica Médica, Disciplina de Reumatologia, Faculdade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
  40. 40 Servicio de Reumatología, Departamento de Especialidades Médicas, Hospital Nacional Edgardo Rebagliati Martins, EsSalud., Lima, Perú
  41. 41 Servicio de Reumatología, CEIBAC, SC, Guadalajara, México
  42. 42 Servicio de Inmunología, Instituto de Investigaciones Médicas "Alfredo "Lanari", Ciudad Autónoma de Buenos Aires, Argentina
  43. 43 Servicio de Reumatología, Hospital Escuela "Eva Perón", Granadero Baigorria, Argentina
  44. 44 Departamento de Inmunología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
  45. 45 Departamento de Reumatología, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México
  46. 46 Unidad de Reumatología, Cátedra de Clínica Médica I, Hospital Córdoba. Cátedra de Semiología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba., Córdoba, Argentina
  47. 47 Rheumatology Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
  48. 48 Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
  49. 49 Departamento de Reumatología, Consultorio de Especialidades del Instituto Salvadoreño de la Seguridad Social, San Salvador, El Salvador
  50. 50 Departamento de Inmunología y Reumatología, Hospital General de Occidente., Zapopan, Jalisco, México.
  51. 51 Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, Mexico
  52. 52 Departamento de Reumatología, Hospital de Especialidades CMN SXXI, IMSS, Ciudad de México, Mexico
  53. 53 Grupo de Trabajo en Enfermedades Autoinmunes Sistémicas, Servicio de Clínica Médica, Facultad de Medicina, Universidad de la Republica, Hospital Pasteur, Administración de Servicios de Salud del Estado, Montevideo, Uruguay
  54. 54 Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ)., La Habana, Cuba
  55. 55 Servicio de Reumatología, Instituto de Rehabilitación Psicofísica (IREP), Ciudad Autónoma de Buenos Aires, Argentina
  56. 56 Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
  57. 57 Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
  1. Correspondence to Dr Mario H Cardiel, Centro de Investigación Clínica de Morelia SC. Morelia, México; mhcardiel{at}hotmail.com

Abstract

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an ‘overarching’ treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.

  • systemic lupus erythematosus
  • treatment
  • lupus nephritis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • BAP-E, EB, ERS and MHC contributed equally.

  • Handling editor Josef S Smolen

  • Contributors All authors listed in this manuscript have participated in planning, drafting, reviewing, final approval and are accountable for all aspects of the manuscript.

  • Funding PANLAR financed the development of these guidelines. PANLAR received unrestricted funds from GlaxoSmithKline (GSK) and UCB Pharma for this endeavour.

  • Disclaimer None of the entities influenced the content of the guidelines.

  • Competing interests LBF, BAPE and OAM have been speakers for GlaxoSmithKline (GSK). JCTB has received research grants from GSK. RMX, ON and JFM have received support grants for meetings from GSK. JAGP has been a lecturer for Roche. ERS has received research grants and has been a lecturer for Roche. JFM has been a clinical researcher for Anthera. MHC has received research grants from Roche and is an advisor for Eli Lilly.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it published Online First. The author affiliations have been updated.

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