Summary of 2019 EULAR Guidelines for Treatment of Systemic Lupus Erythematosus

Asif Hussain; Jawaria Avais; Wardah Nasir

doi:10.70302/jpsim.v2i1.2104

Review Article

Summary of 2019 EULAR Guidelines for Treatment of Systemic Lupus Erythematosus

Asif Hussain

Epping Medical Specialist Centre, Victoria, Australia

Jawaria Avais

Epping Medical Specialist Centre, Victoria, Australia

Wardah Nasir

Epping Medical Specialist Centre, Victoria, Australia

✉ Correspondence: Asif Hussain Email: drasifhussain@gmail.com

DOI https://doi.org/10.70302/jpsim.v2i1.2104

Volume: 2, Issue 1 Pages: 10–14 Published: 13 Mar 2021

Received: 20 Nov 2020 Accepted: 18 Jan 2021 Published Online: 13 Mar 2021

Abstract

SLE is a common rheumatological disease with variable presentations and life-threatening organ involvement, associated with comorbidities and mortality. Many diseases can mimic clinical picture of lupus and treatment strategies are based on many factors including age, pregnancy, comorbidities, toxicities of the drugs and other factor. A clear step wise approach regarding various organ specific issues is helpful. EULAR guidelines are very useful for initiating, stepping up or stepping down the treatment for such cases.
This review summarizes the recently updated 2019 EULAR Guidelines for lupus patients with an aim to help manage the lupus more efficiently for better disease control and prevent complications.

Keywords

SLE treatment EULAR guidelines for lupus Organ specific SLE treatment.

How to Cite This Article

Hussain A, Avais J, Nasir W. Summary of 2019 EULAR Guidelines for Treatment of Systemic Lupus Erythematosus. J Pak Soc Intern Med. 2021;2(1):10–14. doi:10.70302/jpsim.v2i1.2104

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Download Citation: ⭳ RIS (Endnote / Zotero / Mendeley) ⭳ BibTeX (.bib)

Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

References

Medina‐Quiñones CV, Ramos‐Merino L, Ruiz‐Sada P, Isenberg D. Analysis of complete remission in systemic lupus erythematosus patients over a 32‐year period. Arthritis Care Res. 2016l;68(7):981-7.
Zen M, Iaccarino L, Gatto M, Bettio S, Nalotto L, Ghirardello A, Punzi L, Doria A. Prolonged remission in Caucasian patients with SLE: prevalence and outcome. Ann Rheum Dis . 2015;74(12):2117-22.
Dall'Era M, Cisternas MG, Smilek DE, Straub L, Houssiau FA, Cervera R, et al. Predictors of long-term renal outcome in lupus nephritis trials: lesson learned from the Euro-Lupus nephritis cohort. Arthritis Rheumatol. 2015;67(5):1305-13..
Ruperto N, Hanrahan LM, Alarcon GS, Belmont HM, Brey RL, Brunetta P, et al. International consensus for Definition of flare in lupus. Lupus. 2011 Apr;20(5):453-62.
Franklyn K, Lau CS, Navarra SV, Louthrenoo W, Lateef A, Hamijoyo L, et al. Definition and initial validation of a lupus low disease activity state (LLDAS). Ann Rheum Dis . 2016 Sep 1;75(9):1615-21.
Fanouriakis A, Kostopoulou M, Alunno A, Aringer M, Bajema I, Boletis JN, et al. 2019 update of the EULAR recommendations for managing systemic lupus erythematosus. Annals of the Rheumatic Diseases. 2019;78(6):736-45.
Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long term HCQ therapy. JAMA Ophthalmol (2014):132;1453-1460.
Kim JW, Kim YY, Lee H, Park SH, Kim SK, Choe JY. Risk of retinal toxicity in long term use of HCQ. J Rheumatol. 2017 Nov 1;44(11):1674-9.
Ruiz-Arruza I, Lozano J, Cabezas-Rodriguez I, Medina JA, Ugarte A, Erdozain JG, et al. Restrictive use of GC in SLE and prevention of damage without worsening long term disease control: an observational study: Arthritis Care Res. 2018;70(4):582-91.
Singh JA, Hossain A, Kotb A. The risk of serious infections with immunosuppressive drugs and glucocorticoids for lupus nephritis: a systematic review and network meta-analysis. BMC Med. 2016; DOI:10.1186/s12916-016-0673-8. doi:10.1186/s12916-016-0673-8
Touma Z, Gladman DD, Urowitz MB, Beyene J, Uleryk EM, Shah PS. Mycophenolate Mofetil for induction treatment of Lupus Nephritis: a systematic review and meta-analysis. J Rheumatol. 2011 Jan 1;38(1):69-78.
Blumenfeld Z, Mischari O, Schultz N, Boulman N, Balbir-Gurman A. GnRH agonist may minimize cyclophosphamide associated gonadotoxicity in SLE and autoimmune diseases. Semin Arthritis Rheum. 2011;41(3):346-52.
Sakthiswary R, Suresh E. Methotrexate in SLE: a systematic review of its efficacy. Lupus. 2014:23(3);225-35.
Iccarino L, Andreoli L, Bocci EB, Bortoluzzi A, Ceccarelli F, Conti F, et al. Clinical predictors of response and discontinuation of Belimumab in patients with SLE in real-life settings: Results of a large, multi-centric, nationwide study. J Autoimmune. 2018;86(1):1-8.
Duxbury B, Combescure C, Chizzolini C. Rituximab in SLE: an updated systematic review and meta-analysis. Lupus. 2013;22(14):1489-503.
Boletis JN, Marinaki S, Skalioti C, Lionaki SS, Iniotaki A, Sfikakis PP. Rituximab and Mycophenolate for relapsing proliferative lupus nephritis: a long-term prospective study. Nephrol Dial Transplant. 2009;24(7):2157-60.
Kuhn A, Aberer E, Bata-Csargo Z, Caproni M, Dreher A, Frances C, et al. S2k guidelines for treating cutaneous lupus- guided by the European Dermatology Forum incorporating with the EADV. J Eur Acad Dermatol Venerol. 2017;31(3):389-404.
Cobo-Ibanez T, Liza-Santamaria E, Pego-Reigosa JM, Marqués AO, Rúa-Figueroa Í, Fernández-Nebro A, et al. Efficacy and safety of RTX in non-renal SLE: a systematic review. Semin Arthritis Rheum. 2014;44(2):175-85.
Bertsias GK, Ioannidis JPA, Aringer M, Bollen E, Bombardieri S, Bruce IN, et al. EULAR recommendations for the management of SLE with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs. Ann Rheum Dis. 2010;69(12):2074-2082.
Bortoluzzi A, Padovan M, Farina I, Galuppi E, De Leonardis F, Govoni M. Therapeutic strategies in severe neuropsychiatric SLE: experience from a tertiary center. Rheumatismo. 2012;64(4):350-9.
Chaturvedi S, Arnold DM, McCrae KR. splenectomy for immune thrombocytopenia: down but not out. Blood. 2018;131(11);1172-82.
Olfat M, Silverman ED, Levy DM. Rituximab therapy has a rapid and durable response for refractory Cytopenia in childhood-onset SLE. Lupus. 2015;24(9):966-72.
Artim-Esen B, Cebu E, Sahinkaya Y, Ertan S, Pehlivan Ö, Kamali S, et al. Cluster analysis of autoantibodies in 852 patients with SLE from a single center. J Rheumatol. 2014:41(7):1304-10.
Dooley MA, Jayne D, Gimzler EM, Isenberg D, Olsen NJ, Wofsy D, et al. Mycophenolate vs Azathioprine as maintenance therapy for Lupus Nephritis. N Engl J Med. 2011;365(11):1886-95.
Ikeuchi H, Hiromura K, Takahashi S, Mishima K, Sakurai N, Sakairi T, et al. Efficacy and safety of multi-target therapy using a combination of Tacrolimus, MMF, and steroid in patients with active LN. Mod Rheumatol. 2014;24(4): 618-25.
Pengo V, Ruffatti A, Legnani C, Gresele P, Barcellona D, Erba N, et al. Clinical course of high-risk patients with APS. Thromb Haemato.l 2010:8(2);237-42.
Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. European Guidelines on CVS diseases prevention in clinical practice. Eur Heart J. 2016;37(11):2315-81.
Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, Barton J. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med 2018:379(16);1529-39.

Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2021 Journal of Pakistan Society of Internal Medicine.

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[1] Medina‐Quiñones CV, Ramos‐Merino L, Ruiz‐Sada P, Isenberg D. Analysis of complete remission in systemic lupus erythematosus patients over a 32‐year period. Arthritis Care Res. 2016l;68(7):981-7.

[2] Zen M, Iaccarino L, Gatto M, Bettio S, Nalotto L, Ghirardello A, Punzi L, Doria A. Prolonged remission in Caucasian patients with SLE: prevalence and outcome. Ann Rheum Dis . 2015;74(12):2117-22.

[3] Dall'Era M, Cisternas MG, Smilek DE, Straub L, Houssiau FA, Cervera R, et al. Predictors of long-term renal outcome in lupus nephritis trials: lesson learned from the Euro-Lupus nephritis cohort. Arthritis Rheumatol. 2015;67(5):1305-13..

[4] Ruperto N, Hanrahan LM, Alarcon GS, Belmont HM, Brey RL, Brunetta P, et al. International consensus for Definition of flare in lupus. Lupus. 2011 Apr;20(5):453-62.

[5] Franklyn K, Lau CS, Navarra SV, Louthrenoo W, Lateef A, Hamijoyo L, et al. Definition and initial validation of a lupus low disease activity state (LLDAS). Ann Rheum Dis . 2016 Sep 1;75(9):1615-21.

[6] Fanouriakis A, Kostopoulou M, Alunno A, Aringer M, Bajema I, Boletis JN, et al. 2019 update of the EULAR recommendations for managing systemic lupus erythematosus. Annals of the Rheumatic Diseases. 2019;78(6):736-45.

[7] Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long term HCQ therapy. JAMA Ophthalmol (2014):132;1453-1460.

[8] Kim JW, Kim YY, Lee H, Park SH, Kim SK, Choe JY. Risk of retinal toxicity in long term use of HCQ. J Rheumatol. 2017 Nov 1;44(11):1674-9.

[9] Ruiz-Arruza I, Lozano J, Cabezas-Rodriguez I, Medina JA, Ugarte A, Erdozain JG, et al. Restrictive use of GC in SLE and prevention of damage without worsening long term disease control: an observational study: Arthritis Care Res. 2018;70(4):582-91.

[10] Singh JA, Hossain A, Kotb A. The risk of serious infections with immunosuppressive drugs and glucocorticoids for lupus nephritis: a systematic review and network meta-analysis. BMC Med. 2016; DOI:10.1186/s12916-016-0673-8. doi:10.1186/s12916-016-0673-8

[11] Touma Z, Gladman DD, Urowitz MB, Beyene J, Uleryk EM, Shah PS. Mycophenolate Mofetil for induction treatment of Lupus Nephritis: a systematic review and meta-analysis. J Rheumatol. 2011 Jan 1;38(1):69-78.

[12] Blumenfeld Z, Mischari O, Schultz N, Boulman N, Balbir-Gurman A. GnRH agonist may minimize cyclophosphamide associated gonadotoxicity in SLE and autoimmune diseases. Semin Arthritis Rheum. 2011;41(3):346-52.

[13] Sakthiswary R, Suresh E. Methotrexate in SLE: a systematic review of its efficacy. Lupus. 2014:23(3);225-35.

[14] Iccarino L, Andreoli L, Bocci EB, Bortoluzzi A, Ceccarelli F, Conti F, et al. Clinical predictors of response and discontinuation of Belimumab in patients with SLE in real-life settings: Results of a large, multi-centric, nationwide study. J Autoimmune. 2018;86(1):1-8.

[15] Duxbury B, Combescure C, Chizzolini C. Rituximab in SLE: an updated systematic review and meta-analysis. Lupus. 2013;22(14):1489-503.

[16] Boletis JN, Marinaki S, Skalioti C, Lionaki SS, Iniotaki A, Sfikakis PP. Rituximab and Mycophenolate for relapsing proliferative lupus nephritis: a long-term prospective study. Nephrol Dial Transplant. 2009;24(7):2157-60.

[17] Kuhn A, Aberer E, Bata-Csargo Z, Caproni M, Dreher A, Frances C, et al. S2k guidelines for treating cutaneous lupus- guided by the European Dermatology Forum incorporating with the EADV. J Eur Acad Dermatol Venerol. 2017;31(3):389-404.

[18] Cobo-Ibanez T, Liza-Santamaria E, Pego-Reigosa JM, Marqués AO, Rúa-Figueroa Í, Fernández-Nebro A, et al. Efficacy and safety of RTX in non-renal SLE: a systematic review. Semin Arthritis Rheum. 2014;44(2):175-85.

[19] Bertsias GK, Ioannidis JPA, Aringer M, Bollen E, Bombardieri S, Bruce IN, et al. EULAR recommendations for the management of SLE with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs. Ann Rheum Dis. 2010;69(12):2074-2082.

[20] Bortoluzzi A, Padovan M, Farina I, Galuppi E, De Leonardis F, Govoni M. Therapeutic strategies in severe neuropsychiatric SLE: experience from a tertiary center. Rheumatismo. 2012;64(4):350-9.

[21] Chaturvedi S, Arnold DM, McCrae KR. splenectomy for immune thrombocytopenia: down but not out. Blood. 2018;131(11);1172-82.

[22] Olfat M, Silverman ED, Levy DM. Rituximab therapy has a rapid and durable response for refractory Cytopenia in childhood-onset SLE. Lupus. 2015;24(9):966-72.

[23] Artim-Esen B, Cebu E, Sahinkaya Y, Ertan S, Pehlivan Ö, Kamali S, et al. Cluster analysis of autoantibodies in 852 patients with SLE from a single center. J Rheumatol. 2014:41(7):1304-10.

[24] Dooley MA, Jayne D, Gimzler EM, Isenberg D, Olsen NJ, Wofsy D, et al. Mycophenolate vs Azathioprine as maintenance therapy for Lupus Nephritis. N Engl J Med. 2011;365(11):1886-95.

[25] Ikeuchi H, Hiromura K, Takahashi S, Mishima K, Sakurai N, Sakairi T, et al. Efficacy and safety of multi-target therapy using a combination of Tacrolimus, MMF, and steroid in patients with active LN. Mod Rheumatol. 2014;24(4): 618-25.

[26] Pengo V, Ruffatti A, Legnani C, Gresele P, Barcellona D, Erba N, et al. Clinical course of high-risk patients with APS. Thromb Haemato.l 2010:8(2);237-42.

[27] Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. European Guidelines on CVS diseases prevention in clinical practice. Eur Heart J. 2016;37(11):2315-81.

[28] Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, Barton J. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med 2018:379(16);1529-39.