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Update οn the diagnosis and management of systemic lupus erythematosus
  1. Antonis Fanouriakis1,
  2. Nikolaos Tziolos2,
  3. George Bertsias3,4,
  4. Dimitrios T Boumpas2,5,6,7
  1. 1 Department of Rheumatology, "Asklepieion" General Hospital, Athens, Greece
  2. 2 4th Department of Internal Medicine, "Attikon" University Hospital, Athens, Greece
  3. 3 Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Crete, Greece
  4. 4 Laboratory of Autoimmunity-Inflammation, Institute of Molecular Biology and Biotechnology, Heraklion, Crete, Greece
  5. 5 Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
  6. 6 Medical School, University of Cyprus, Nicosia, Cyprus
  7. 7 Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Cyprus
  1. Correspondence to Dr Dimitrios T Boumpas, 4th Department of Internal Medicine, "Attikon" University Hospital, Athens 124 62, Greece; boumpasd{at}


Clinical heterogeneity, unpredictable course and flares are characteristics of systemic lupus erythematosus (SLE). Although SLE is—by and large—a systemic disease, occasionally it can be organ-dominant, posing diagnostic challenges. To date, diagnosis of SLE remains clinical with a few cases being negative for serologic tests. Diagnostic criteria are not available and classification criteria are often used for diagnosis, yet with significant caveats. Newer sets of criteria (European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019) enable earlier and more accurate classification of SLE. Several disease endotypes have been recognised over the years. There is increased recognition of milder cases at presentation, but almost half of them progress overtime to more severe disease. Approximately 70% of patients follow a relapsing-remitting course, the remaining divided equally between a prolonged remission and a persistently active disease. Treatment goals include long-term patient survival, prevention of flares and organ damage, and optimisation of health-related quality of life. For organ-threatening or life-threatening SLE, treatment usually includes an initial period of high-intensity immunosuppressive therapy to control disease activity, followed by a longer period of less intensive therapy to consolidate response and prevent relapses. Management of disease-related and treatment-related comorbidities, especially infections and atherosclerosis, is of paramount importance. New disease-modifying conventional and biologic agents—used alone, in combination or sequentially—have improved rates of achieving both short-term and long-term treatment goals, including minimisation of glucocorticoid use.

  • lupus erythematosus
  • systemic
  • lupus nephritis
  • therapeutics
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  • Handling editor Josef S Smolen

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  • Contributors DTB conceived and drafted the manuscript. NT contributed to preparation of figures. AF and GB edited the manuscript. All authors read and approved the final form.

  • Funding Part of this work has been supported by research grants from FOREUM (Foundation for Research in Rheumatology) to DTB and GB and from the European Research Council (ERC) under the European Union’s Horizon 2020 Research and Innovation programme (grant agreement no 742390) to DTB.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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