2023 Updates to EULAR Recommendations for Management of Systemic Lupus Erythematosus

The European Alliance of Associations for Rheumatology (EULAR) has updated its recommendations for the management of systemic lupus erythematosus (SLE) based on emerging new evidence. For the 2023 updated recommendations, a Task Force of world-leading experts in the field of SLE from four continents were assembled to conduct a systematic literature review. The Task Force agreed on 5 overarching principles and condensed recommendations to a total of 13.

To set the overall framework for approaching treatment in people with SLE and the role of physician-patient interaction, the group agreed on five principles, such as SLE requires multidisciplinary, individualized management with patient education and shared decision-making, taking into consideration the costs to patient and society, and SLE disease activity should be assessed at each clinic visit (the frequency depending on physician’s discretion), with evaluation of organ damage (at least annually), using validated instruments.

The Task Force agreed upon 13 recommendations in the areas of optimal use of commonly used drugs (1-4), organ manifestations (5-12) and additional treatments and comorbidities. Recommendation highlights include:

• Hydroxychloroquine (HCQ) should be given to all people with lupus at a target dose of 5 mg/kg real body weight/day and should consider the individual’s risk for flares and retinal toxicity.
• Glucocorticoids should be used as ‘bridging therapy’ during periods of disease activity, and should be minimized and, when possible, withdrawn for maintenance treatment.
• Considering cyclophosphamide and rituximab in organ-threatening and refractory disease, respectively.
• Different patient characteristics should be considered in the management of lupus nephritis, using a combination therapy with either belimumab or a calcineurin inhibitor (an immunosuppressive that works to inhibit calcineurin, an enzyme that activates T-cells in the immune system).
• A holistic approach to care for people with lupus requiring immunosuppressive therapy and those in need of complimentary therapies.
• Defining quality indicators in a table format to serve as a checklist for providers and support adherence.

The new 2023 recommendations provide updated guidance to physicians treating SLE around the world, as well as recommendations for future research.

Read the recommendations