First UK Guidelines for Adults with Lupus

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Mariah Zebrowski Leach, JD, MS

Tuesday, November 7, 2017

Lupus

The first UK guidelines on the care of adults with systemic lupus erythematosus (SLE) were published recently by the British Society for Rheumatology.

Because general recommendations for the management of SLE have not been published since 2008, up-to-date guidelines were warranted to help improve patient outcomes, noted the multidisciplinary group that developed them.

The group included academic and NHS consultants in rheumatology and nephrology, rheumatology trainees, a general practitioner, a clinical nurse specialist, a patient representative, and a lay member. The opinions of other key stakeholders, such as podiatrists, nurse specialists, and representatives of Lupus UK, were also solicited.

The guidelines were published in Rheumatology.

The recommendations are based on an extensive literature review (to June 2015) of non-renal SLE, supplemented as necessary by UK expert opinion and consensus agreement. The finalized guidelines have been accredited by the National Institute for Health and Care Excellence. The primary objective was to provide comprehensive, evidence-based recommendations that cover diagnosis, assessment, monitoring, and treatment of mild, moderate, and severe active SLE.

Recommendations for diagnosis

• Diagnosis requires the presence of at least 1 relevant immunological abnormality. Blood tests, including serological marker tests, should be checked.

• If the ANA test is negative, the clinical probability of SLE is low.

• Anti-dsDNA antibodies, low complement levels, and anti-Smith antibodies are highly predictive of SLE.

• aPLs should be tested at baseline in all patients who have SLE, especially those with an adverse pregnancy history or arterial/venous thrombotic events.

Recommendations for assessment

• Ascertaining whether clinical manifestations are the result of active inflammation or thrombosis is important, because this will define treatment strategies.

• Clinical assessment should include a thorough history and review of systems, full clinical examination and monitoring of vital signs, urinalysis, laboratory tests, assessment of health status and quality of life, and measurement of disease activity and damage using standardized SLE assessment tools. When indicated, imaging, renal, and other biopsies should be performed.

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