2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

被引：1637

作者：

Fanouriakis, Antonis ^{[1
]}

Kostopoulou, Myrto ^{[2
]}

Alunno, Alessia ^{[3
]}

Aringer, Martin ^{[4
,5
]}

Bajema, Ingeborg ^{[6
]}

Boletis, John N. ^{[7
,8
]}

Cervera, Ricard ^{[9
]}

Doria, Andrea ^{[10
]}

Gordon, Caroline ^{[11
]}

Govoni, Marcello ^{[12
]}

Houssiau, Frederic ^{[13
]}

Jayne, David ^{[14
]}

Kouloumas, Marios ^{[15
]}

Kuhn, Annegret ^{[16
]}

Larsen, Janni L. ^{[17
]}

Lerstrom, Kirsten ^{[18
]}

Moroni, Gabriella ^{[19
]}

Mosca, Marta ^{[20
]}

Schneider, Matthias ^{[21
,22
]}

Smolen, Josef S. ^{[23
]}

Svenungsson, Elisabet ^{[24
,25
]}

Tesar, Vladimir ^{[26
,27
]}

Tincani, Angela ^{[28
]}

Troldborg, Anne ^{[29
]}

van Vollenhoven, Ronald ^{[30
]}

Wenzel, Joerg ^{[31
]}

Bertsias, George ^{[32
]}

Boumpas, Dimitrios T. ^{[1
,33
,34
,35
]}

机构：

[1] Attikon Univ Hosp, Rheumatol & Clin Immunol Unit, Athens 12462, Greece

[2] G Gennimatas Gen Hosp, Dept Nephrol, Athens, Greece

[3] Univ Perugia, Dept Med, Rheumatol Unit, Perugia, Italy

[4] Tech Univ Dresden, Univ Med Ctr, Dept Med 3, Div Rheumatol, Dresden, Germany

[5] Tech Univ Dresden, Fac Med Carl Gustav Carus, Dresden, Germany

[6] Leiden Univ, Med Ctr, Dept Pathol, Leiden, Netherlands

[7] Natl & Kapodistrian Univ Athens, Laikon Hosp, Sch Med, Dept Nephrol, Athens, Greece

[8] Natl & Kapodistrian Univ Athens, Laikon Hosp, Sch Med, Renal Transplantat Unit, Athens, Greece

[9] Hosp Clin Barcelona, Dept Autoimmune Dis, Barcelona, Spain

[10] Univ Padua, Dept Med, Rheumatol Unit, Padua, Italy

[11] Univ Birmingham, Inst Inflammat & Ageing, Rheumatol Res Grp, Birmingham, W Midlands, England

[12] Univ Ferrara, Azienda Osped Univ St Anna Ferrara, Rheumatol Sect, Dept Med Sci, Ferrara, Italy

[13] Catholic Univ Louvain, Clin Univ St Luc, Brussels, Belgium

[14] Addenbrookes Hosp, Dept Med, Cambridge, England

[15] Cyprus League Rheumatism, Aglantzia, Cyprus

[16] Univ Hosp Muenster, Munster, Germany

[17] Rigshosp, Rheumatol & Spine Dis Ctr, Copenhagen Lupus & Vasculitis Clin, Copenhagen, Denmark

[18] Lupus Europe, Farum, Denmark

[19] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Nephrol Unit, Milan, Italy

[20] Univ Pisa, Dept Clin & Expt Med, Rheumatol Unit, Pisa, Italy

[21] Heinrich Heine Univ, Dept Rheumatol, Dusseldorf, Germany

[22] Heinrich Heine Univ, UKD, Hiller Res Unit Rheumatol, Dusseldorf, Germany

[23] Med Univ Vienna, Dept Med 3, Div Rheumatol, Vienna, Austria

[24] Karolinska Inst, Dept Med, Rheumatol Unit, Stockholm, Sweden

[25] Karolinska Univ Hosp, Stockholm, Sweden

[26] Charles Univ Prague, Fac Med 1, Dept Nephrol, Prague, Czech Republic

[27] Charles Univ Prague, Gen Univ Hosp, Prague, Czech Republic

[28] Univ Brescia, Rheumatol & Clin Immunol, Brescia, Italy

[29] Aarhus Univ Hosp, Dept Rheumatol, Aarhus, Denmark

[30] Univ Amsterdam, Med Ctr, Dept Rheumatol & Clin Immunol, Amsterdam, Netherlands

[31] Univ Hosp Bonn, Dept Dermatol & Allergy, Bonn, Germany

[32] Univ Hosp Heraklion, Rheumatol Clin Immunol & Allergy, Iraklion, Greece

[33] Acad Athens, Biomed Res Fdn, Lab Autoimmun & Inflammat, Athens, Greece

[34] Natl & Kapodestrian Univ Athens, Sch Med, Joint Acad Rheumatol Program, Athens, Greece

[35] Univ Cyprus, Sch Med, Nicosia, Cyprus

来源：

ANNALS OF THE RHEUMATIC DISEASES | 2019年 / 78卷 / 06期

关键词：

LOW DISEASE-ACTIVITY; B-LYMPHOCYTE STIMULATOR; LOW-DOSE ASPIRIN; OFF-LABEL USE; MYCOPHENOLATE-MOFETIL; CARDIOVASCULAR EVENTS; DOUBLE-BLIND; NEUROPSYCHIATRIC LUPUS; PROLONGED REMISSION; PRIMARY PREVENTION;

D O I：

10.1136/annrheumdis-2019-215089

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

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.

引用

页码：736 / 745

页数：10

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