Table 2 Category of evidence and strength of statements
Recommendation/itemNo. of studies evaluatedCategory of evidenceStrength of statementMean level of agreement*
Prognosis. Prognostic value of:
Clinical features
    Rashes44B8.6
    Arthritis44B8.7
    Serositis64B8.6
    Seizures/psychosis94B9.0
Laboratory findings
    Severe anaemia104B8.0
    Leucopenia/lymphopenia45C8.0
    Thrombocytopenia154B8.0
    Serum creatinine204B9.2
    Proteinuria/urinary sediment244B9.3
    C3/C4134B8.4
    Anti-dsDNA174B8.7
    Anti-Ro/SSA64B7.7
    Anti-La/SSB15C7.7
    Antiphospholipid194B8.5
    Anti-RNP34B7.6
Imaging
    Brain MRI74B8.7
Pathology
    Renal biopsy334B9.5
Monitoring. Diagnostic ability of:
Rashes15C8.8
Anaemia14B8.3
Lymphopenia14B
Thrombocytopenia15C
C3/C4134B8.8
Anti-C1q84B7.7
Anti-dsDNA154B8.7
Comorbidities. Increased risk for:
Infections135C8.6
    Urinary-tract infections14B8.9
    Atherosclerosis144B8.8
    Hypertension74B9.4
    Dyslipidaemia74B9.2
    Diabetes35C8.9
    Osteoporosis65C9.1
    Avascular necrosis85C8.6
Neoplasms8.7
    Non-Hodgkin’s lymphomas64B
    Other104B
Therapy of uncomplicated SLE
Antimalarials42A9.4
NSAIDs1D8.8
Glucocorticoids32A9.1
Azathioprine14B9.3
Mycophenolate mofetil46D6.9
Methotrexate32A8.0
Adjunct therapy in SLE
Photoprotection14B9.2
Smoking cessationD9.3
Weight controlD
ExerciseD
Low-dose aspirin14D†9.0
Calcium/vitamin D52A9.2
Biphosphonates22A8.5
StatinsD8.9
AntihypertensivesD8.9
Oral contraceptives (safe use)22A9.1
Hormone-replacement therapy32A9.1
Diagnosis of neuropsychiatric lupus8.1‡
Clinical features
    Headache (not related)13A
    Anxiety15C
    Depression15C
    Cognitive impairment34B
Laboratory tests
    EEG34B
    Anti-P64B
    Antiphopholipid44B
Neuropsychological tests35C
Imaging tests
    CT34B
    MRI94B
    PET24B
    SPECT55C
    MTI55C
    DWI15C
    MRS35C
    T2 relaxation time25C
Treatment of neuropsychiatric lupus
Immunosuppressants (CY) in combination with glucocorticoids102A9.2
Pregnancy
Fertility not impaired45C8.8
Increased lupus activity/flares113B8.8
Increased risk for pre-eclampsia64B9.8
Increased risk for miscarriage/stillbirth/premature delivery304B9.4
Increased risk for intrauterine growth restriction65C
Increased risk for fetal congenital heart block74B
Therapy during pregnancy
    Prednisolone66D9.6
    Azathioprine56D9.2
    HCQ92A9.5
    Low-dose aspirin16D9.3
Antiphospholipid syndrome
Primary prevention of thrombosis/pregnancy loss
    Low-dose aspirinD8.7
Secondary prevention of thrombosis/pregnancy loss
    Oral anticoagulants (non-pregnant patients)82A9.0
    Unfractionated/LMW heparin and aspirin (pregnant patients)141A9.1
Nephritis: monitoring
Repeat renal biopsy64B9.5
Urinary sediment24B
Proteinuria104B
Serum creatinine84B
Anti-dsDNA34B8.7
C324B
Nephritis: treatment
Combined glucocorticoids and immunosuppressants are effective against ESRD211A9.3
MMF has similar efficancy to pulse CY in short-/medium-term trials82A9.2
CY efficacy in long-term trials131A9.5
End-stage renal disease in SLE
Dialysis is safe in SLE73B8.8
Transplantation is safe in SLE93B
Transplantation is superior to dialysis259.4
  • *Mean level of agreement of the Task Force members on each sub-item/statement; †in elderly SLE patients, low-dose aspirin is associated with improved cognitive function (4/B); ‡this refers to the statement that “in SLE patients, the diagnostic work-up (clinical, laboratory, neuropsychological and imaging tests) of neuropsychiatric manifestations should be similar to that in the general population presenting with the same neuropsychiatric manifestations”; §non-SLE studies.