SLE (or lupus) is a complex, multi-system autoimmune disease that affects nearly 1 in 1000 people in the UK [1]. K.S. The diagnosis requires a combination of clinical features and the presence of at least one relevant immunological abnormality. Histologic effects of MicroPulseâ„¢ transscleral cyclophotocoagulation in normal equine eyes. Due to essential maintenance work, you won't be able to log in to the website today. Scleroderma Renal Crisis as an Early Presentation of Systemic Sclerosis. Typical manifestations attributed to lupus, Fatigue, malar rash, diffuse alopecia, mouth ulcers, arthralgia, myalgia, platelets 50–149 × 10, Fever, lupus-related rash up to 2/9 body surface area, cutaneous vasculitis, alopecia with scalp inflammation, arthritis, pleurisy, pericarditis, hepatitis, platelets 25–49 × 10, Rash involving >2/9 body surface area, myositis, severe pleurisy and/or pericarditis with effusion, ascites, enteritis, myelopathy, psychosis, acute confusion, optic neuritis, platelets <25 × 10, Initial typical drugs and target doses if no contra-indications, Aiming for typical maintenance drugs/doses providing no contra-indications, Aim to reduce and stop drugs except HCQ eventually when in stable remission, Copyright © 2020 British Society for Rheumatology. For the purpose of identifying patients in clinical studies, a person shall be said to have systemic lupus erythematosus if any 4 or more of the 11 criteria are present, serially or simultaneously, during any interval of observation (64,65). To provide comprehensive recommendations, covering the diagnosis, assessment, monitoring and treatment of mild, moderate and severe active lupus disease based on a literature review (to June 2015) for non-renal lupus, supplemented as necessary by UK expert opinion and consensus agreement, and that do not imply a legal obligation. Disease activity is categorized into mild, moderate and severe, with the occurrence of flares (2+/C). ... Lupus. If you need to renew your membership or check something related to it, please contact membership@rheumatology.org.uk. Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham. A descriptive analysis was undertaken of each infusion reaction, which was then assessed using the clinical information available to hypothesise on the possible underlying mechanism(s). Patients with lupus are at increased risk of co-morbidities, such as atherosclerotic disease, osteoporosis, avascular necrosis, malignancy and infection (2+/C). Also prescribed for psoriasis, atopic dermatitis and ��Q�Y��,};�,;K�����rծ�&�/����a/�pb7�C���ͦ �������u�-nߖ>|�54�`��{.���#�z �k�o�KE��ӾD�B��r4��GD�@X��{@X���,@" �� has consulted for Merck Serono, Eli Lilly, Celegene, UCB, XTLBio, Anthera and Baxalta; the honoraria received have been passed on to a local arthritis charity. The management of the complications of lupus (including chronic fatigue, thrombosis, cardiovascular risk, osteoporosis, infection and cancer risk) are not discussed in detail and should be managed as for patients with similar risk factors according to relevant national and international guidelines. To undertake a retrospective review of patients with SLE who had received Rituximab in order to determine the rates and associated patient characteristics of clinically significant adverse infusion reactions. doses of methylprednisolone (2+/C). D.J. Higher performance with nephritis screening in dedicated clinics supports wider adoption of this service-delivery mod … Anti-Ro,/La and anti-RNP antibodies are less-specific markers of SLE (2+/C) as they are found in other autoimmune rheumatic disorders as well as SLE (2+/C) (SOA 95%). The presence of anti-dsDNA antibodies (2 ++/B), low complement levels (2 ++/C) or anti-Smith (Sm) antibodies (2+/C) are highly predictive of a diagnosis of SLE in patients with relevant clinical features. doi: 10.1093/rheumatology/kex286. Treatments to be considered for the management of mild non–organ-threatening disease include the disease-modifying drugs HCQ (1 ++/A) and MTX (1+/A), and short courses of NSAIDs (3/D) for symptomatic control. Antinuclear antibody titer is the primary laboratory test used to diagnose systemic lupus erythematosus. BSR's 'gold standard' clinical guidelines support evidence-based clinical practice in rheumatology. Please check for further notifications by email. Also prescribed for RA, SLE, lupus nephritis and inflammatory myopathy such as dermatomyositis & polymyositis. ANA are present in ∼95% of SLE patients. Keywords Lupus, cutaneous (CLE) and systemic lupus erythematosus (SLE), ‘discoid’ lupus erythematosus (DLE), efficacy endpoints, disease activity indices, claims . the British Society for Rheumatology Standards, Audit and Guidelines Working Group Key words: lupus, diagnosis, assessment, monitoring, management, immunosuppressants, treatment, efficacy, non-biologics, biologics. Difficult-to-treat rheumatoid arthritis: contributing factors and burden of disease, A rare case of small-vessel necrotizing vasculitis of the bone marrow revealing granulomatosis with polyangiitis, Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach, Real-world single centre use of JAK inhibitors across the rheumatoid arthritis pathway, The management of Sjögren’s syndrome: British Society for Rheumatology guideline scope, About the British Society for Rheumatology, https://doi.org/10.1093/rheumatology/kex291, https://www.england.nhs.uk/wp-content/uploads/2013/09/a13-psa.pdf, Receive exclusive offers and updates from Oxford Academic. For Permissions, please email: journals.permissions@oup.com. Diagnosing Dyspneic Older Adult Emergency Department Patients: A Pilot Study. has received honoraria from Pfizer. methylprednisolone (2+/C) or high-dose oral prednisolone (up to 1 mg/kg/day) (4/D) to induce remission, either on their own or more often as part of a treatment protocol with another immunosuppressive drug (4/D) (SOA 98%). They can also reduce the risk of long-term damage accrual (4/D) (SOA 98%). BSPAR Guidelines. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis. IVIG (2-/D) and plasmapheresis (3/D) may be considered in patients with refractory cytopaenias, thrombotic thrombocytopaenic purpura (1+/B), rapidly deteriorating acute confusional state and the catastrophic variant of APS (SOA 93%). Neonatal lupus — Neonatal lupus is a passively acquired autoimmune disease that occurs in about 2 percent of babies born to mothers with anti-Ro/SSA and/or anti-La/SSB antibodies. Immunosuppressive regimens for severe active SLE involve i.v. Treatment in SLE aims at remission or low disease activity and prevention of flares. Reimbursement for rituximab is limited to the NHS England 2013 Interim Clinical Commissioning Policy statement for rituximab in adult SLE patients (https://www.england.nhs.uk/wp-content/uploads/2013/09/a13-psa.pdf). has undertaken consultancies and received honoraria from Astra-Zeneca, GlaxoSmithKline, MedImmune, Merck Serono, Pfizer, Roche and UCB, has been a member of the speakers’ bureau for GlaxoSmithKline, UCB and Pfizer and has received research grant income from Genzyme Sanofi, GlaxoSmithKline, UCB and Roche. Scope and purpose of the guideline Need for the guideline SLE (or lupus) is a complex, multi-system autoimmune Close monitoring of drugs by regular laboratory tests and clinical assessment should be performed in accordance with drug monitoring guidelines (4/D) (SOA 98%). has received funding to attend scientific meetings and received honoraria from UCB. General recommendations for the management of lupus have not been published since 2008, although European and USA guidelines for LN management were published in 2012 [3–5]. Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, affecting almost 1 in 1000 people in the UK in 2012. M.G. The guidelines address the management of adult patients only and have been developed by a multidisciplinary guideline development group set up by the BSR. Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Diagnosing lupus can be challenging as lupus causes a large variety of clinical features affecting any system in the body with a wide differential diagnosis and expert advice is required to confirm the diagnosis (see … The smallest effective dose of CS should be used. S.B. Thank you for submitting a comment on this article. The diagnosis of lupus requires a combination of relevant clinical features and at least one immunological abnormality (as discussed below) according to the BSR guideline for lupus. Management of specific clinical manifestations 175 6.1. has received funding to attend scientific meetings and received honoraria from UCB and GlaxoSmithKline. Detailed dosing regimens are beyond the scope of this document. Factor VIII inhibitor acquired autoimmune antiphospholipid syndrome antiphospholid antibodies thrombophilia lupus anticoagulant anticardiolipin antiphospholipid b2–glycoprotein I … The clinical guideline is accredited by the National Institute for Health and Care Excellence (NICE) . has received research funding in grants/in kind from Roche and Genentech, has acted as an advisor to Genentech, Medimmune and Rigel and has received honoraria/travel grants from Genentech, Roche and UCB. I.N.B. 4 0 obj 1 Corrigendum pertains to typing errors in section 5.1.1: “SIS<4” should read “SRI<4” and “SLI as primary endpoints” should read “S RI as primary endpoints”. No one test can diagnose lupus. Accreditation is valid for 5 years from 10 June 2013. Bach2 overexpression represses Th9 cell differentiation by suppressing IRF4 expression in systemic lupus erythematosus. The target audience for the guideline includes rheumatologists and other clinicians that care for lupus patients such as nephrologists, immunologists, dermatologists, emergency medicine, GPs, trainees, clinical nurse specialists, and other allied health professionals. Despite improvement in survival over the last 40 years, lupus patients still die on average 25 years earlier than the mean for women and men in the UK [2]. B.G. received funding to attend a scientific meeting from Daiichi Sankyo. SLE treatment strategies for examples of mild, moderate and severe non-renal lupus, CSsa: topical preferred or oral prednisolone ≤20 mg daily for 1–2 weeks or, or i.v. Prednisolone treatment at a low dose of ⩽7.5 mg/day may be required for maintenance therapy (2+/C). 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