TY - JOUR T1 - 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 736 LP - 745 DO - 10.1136/annrheumdis-2019-215089 VL - 78 IS - 6 AU - Antonis Fanouriakis AU - Myrto Kostopoulou AU - Alessia Alunno AU - Martin Aringer AU - Ingeborg Bajema AU - John N Boletis AU - Ricard Cervera AU - Andrea Doria AU - Caroline Gordon AU - Marcello Govoni AU - Frédéric Houssiau AU - David Jayne AU - Marios Kouloumas AU - Annegret Kuhn AU - Janni L Larsen AU - Kirsten Lerstrøm AU - Gabriella Moroni AU - Marta Mosca AU - Matthias Schneider AU - Josef S Smolen AU - Elisabet Svenungsson AU - Vladimir Tesar AU - Angela Tincani AU - Anne Troldborg AU - Ronald van Vollenhoven AU - Jörg Wenzel AU - George Bertsias AU - Dimitrios T Boumpas Y1 - 2019/06/01 UR - http://ard.bmj.com/content/78/6/736.abstract N2 - 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treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn.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. ER -