Treatment Algorithms in Systemic Lupus Erythematosus

Abstract

Objective. To establish agreement on systemic lupus erythematosus (SLE) treatment. Methods. SLE experts (n 5 69) were e-mailed scenarios and indicated preferred treatments. Algorithms were constructed and agreement determined ( ‡50% respondents indicating ‡70% agreement). Results. Initially, 54% (n 5 37) responded suggesting treatment for scenarios; 13 experts rated agreement with scenarios. Fourteen of 16 scenarios had agreement as follows: discoid lupus: first-line therapy was topical agents and hydroxychloroquine and/or glucocorticoids then azathioprine and subsequently mycophenolate (mofetil); uncomplicated cutaneous vasculitis: initial treatment was glucocorticoids 6 hydroxychloroquine 6 methotrexate, followed by azathioprine or mycophenolate and then cyclophosphamide; arthritis: initial therapy was hydroxychloroquine and/or glucocorticoids, then methotrexate and subsequently rituximab; pericarditis: first-line therapy was nonsteroidal antiinflammatory drugs, then glucocorticoids with/without hydroxychloroquine, then azathioprine, mycophenolate, or methotrexate and finally belimumab or rituximab, and/or a pericardial window; interstitial lung disease/alveolitis: induction was glucocorticoids and mycophenolate or cyclophosphamide, then rituximab or intravenous gamma globulin (IVIG), and maintenance followed with azathioprine or mycophenolate; pulmonary hypertension: glucocorticoids and mycophenolate or cyclophosphamide and an endothelin receptor antagonist were initial therapies, subsequent treatments were phosphodiesterase-5 inhibitors and then prostanoids and rituximab; antiphospholipid antibody syndrome: standard anticoagulation with/ without hydroxychloroquine, then a thrombin inhibitor for venous thrombosis, versus adding aspirin or platelet inhibition drugs for arterial events; mononeuritis multiplex and central nervous system vasculitis: first-line therapy was glucocorticoids and cyclophosphamide followed by maintenance with azathioprine or mycophenolate, and then rituximab, IVIG, or plasmapheresis; and serious lupus nephritis: first-line therapy was glucocorticoids and mycophenolate, then cyclophosphamide then rituximab. Conclusion. We established variable agreement on treatment approaches. For some treatment decisions there was good agreement between experts even if no randomized controlled trial data were available.

Modern Opportunities in Uveitis Treatment

“…Благодаря этому плазмаферез активно применяется при аутоиммунных заболеваниях, таких как системная красная волчанка, ревматоидный артрит, псориаз и др. [42,[44][45][46][47].…”

Hydroxychloroquine in Systemic Lupus Erythematosus: Comment on the Article by Muangchan et al

“…We have read with interest the original article by Muangchan et al (1), published recently in Arthritis Care & Research and proposing treatment algorithms in systemic lupus erythematosus (SLE). This is an interesting and important work that will help physicians to choose the most appropriate treatments.…”

Treatment Considerations of Lung Involvement in Rheumatologic Disease

“…A recent consensus on the treatment of SLE proposed induction therapy with corticosteroids alone or in association with cyclophosphamide or mycophenolate mofetil, and maintenance therapy with azathioprine or mycophenolate [70]. As second-line therapy, the use of rituximab was suggested [70]. …”