Date Published: 6 October 2017

New guidelines to improve diagnosis and treatment of lupus

A new guideline for the management of systemic lupus erythematosus (also known as SLE, and simply 'lupus') in adults has just been made available by the British Society of Rheumatology 1. Published today [6 Oct'17] in the journal Rheumatology, the new guideline includes information about the diagnosis, assessment, monitoring and treatment of patients with mild, moderate and severe lupus. It is the UK's first2 guideline on the care of adults with systemic lupus erythematosus (lupus).

What is Lupus

Systemic lupus erythematosus (hereafter referred to in its shorter common 'lupus' ) is a multisystem, autoimmune disease that can develop and become apparent at any age. It is most commonly in women in their reproductive years but it is increasingly found after the age of 40, particularly in Europeans. Lupus affected nearly 1 in 1000 of the UK population in 2012 and is most frequently observed in people of African-Caribbean and South Asian descent2. It is a disease of which relapses and remissions can occur, sometimes with considerable morbidity following flares of disease activity and accumulated damage. The increased risk of premature death is mostly due to infection or cardiovascular disease. About one third of lupus patients in the UK develop lupus nephritis2.

More about the new guideline

The recently published guideline is an important new reference that provides advice about how to monitor people for evidence of improvement or deterioration. It encourages the use of various different treatments to reduce reliance on steroids to control symptoms. It also includes information about which drugs might be appropriate for people that do not respond to initial treatment plans.

While this document advises about the care of patients with common symptoms such as skin rashes and arthritis as well as those with less common but potentially more serious problems like kidney disease, it also emphasises the need for people with the most serious and difficult to control forms of lupus to be referred to specialised lupus centres to access new therapies and multi-disciplinary teams.

Lead author of the new guidleline Prof. Caroline Gordon, a lupus expert at Birmingham University, England, explained that 2:

" Lupus can affect any part of the body and can be difficult to diagnose and treat. It is more common than many people realise, has a major impact on the health and activities of individuals with the disease and it is associated with a significant risk of dying prematurely - reducing average lifespan by about 25 years.
_This guideline is essential because it provides advice on how to diagnose the condition and then how to assess the disease and determine what type of treatment will be most suitable, whether people have common manifestations such as skin rashes and arthritis, or less common but potentially more serious problems such as kidney disease
."

The new guideline is intended for use by rheumatologists and clinical nurse specialists in lupus, as well as nephrologists, immunologists, dermatologists, emergency medicine practitioners and GPs.

Prof Gordon went on to say that 2 :

" As a result of this guideline I would expect that patients will experience measurable improvements in care.
_With earlier diagnosis and more appropriate treatment we should see more rapid resolution of symptoms, reduction in disease flares and improvements in the quality of life of patients, with less long-term complications of the disease and its treatment and improved survival rates
."

Details of the information contained in this guideline can be found at academic.oup.com (still avail last time we checked in Nov 2017).

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