This week, the American College of Rheumatology (ACR) released updated guidelines for the treatment and management of systemic lupus erythematosus (SLE), the most common form of lupus. The new guidelines aim to reach and preserve remission or low disease activity, reduce organ damage, lower morbidity and mortality rates, and reduce treatment-related side effects and toxicities in people with SLE. The guidelines also place a strong emphasis on shared-decision making and encourage patients and providers to work together to identify treatment preferences. The updated, consensus-based guidelines are applicable to children and adults with SLE.
The guidelines propose:
Broad, routine use of hydroxychloroquine, minimizing glucocorticoid exposure, and timely introduction of standard and/or biologicimmunosuppressive medications(e.g., cyclophosphamide, mycophenolic acid, azathioprine, methotrexate, belimumab, anifrolumab, and anti-CD20 therapies). Selection of these therapies should be individualized based on disease manifestations and the specific organs affected. ACR underscores the role of shared decision-making between people living with SLE and clinicians, as multiple factors impact therapeutic choices.
Regular follow-up appointments to assess lupus disease activity and changes in symptoms with additional annual evaluation for long-term damage caused by lupus.
Aggressive use of high-dose intravenous steroids during severe flares involving vital organs, followed by gradual reduction in oral doses of steroids.
Physician-managed tapering of steroid use to 5 mg daily or lower, ideally stopping within 6 months if lupus is stable.
Additionally, when evidence-based data, clinical expertise, and patient-reported experiences and preferences do not clearly favor one medication over another, therapy recommendations should be presented without a specific order of preference. It is crucial that all treatment decisions are tailored to the individual and involve shared decision-making, which is vital for respecting values and preferences of people with SLE.
The new guidelines acknowledge that there may be challenges in implementing these recommendations due to limited access to testing, specialists, procedures, and medications. If recommended therapies are unavailable, not well-tolerated, or not preferred, discussions about reasonable alternative treatments are encouraged. Collaborative care between rheumatologists and other specialists is also encouraged.
Notably, the revised guidelines can help to address healthcare disparities, which significantly impact outcomes for individuals with SLE. The Lupus Foundation of America has been committed to advancing health equity in lupus by uncovering and addressing the causes of differences in health outcomes across diverse populations living with lupus. Learn more about Lupus AIM (Addressing health Inequities in Minorities).
This announcement marks an important first step towards precision medicine for SLE. The full guidelines will be submitted for publication in Arthritis & Rheumatology and Arthritis Care and Research. The LFA is committed to keeping you updated along the way. As more details become available, we’ll provide you with tools and resources to better understand SLE and the role these guidelines play in helping you achieve optimal outcomes.
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