This young girl shows the
characteristic malar rash
seen in lupus. The rash
[mobile-ad name="Advert 1"]tends to spare the eyelids
and nasolabial folds. (Click to enlarge.)
CHICAGO—At ACR Convergence 2025, the new 2025 ACR Guideline for the Treatment of Systemic Lupus Erythematosus (SLE) was unveiled.1
Guideline Development & Key Recommendations
Lisa Sammaritano, MD, professor of clinical medicine at Weill Cornell Medical College and the Hospital for Special Surgery, New York, kicked off the session by explaining the guideline development process.
The guideline was last published in 1999, and lupus treatment has significantly evolved since that time, including the introduction of new biologic therapies, belimumab and anifrolumab, approved by the U.S. Food & Drug Administration (FDA).
The process involved scoping articles, developing 52 broad PICO [patient/population/problem, intervention, comparison, outcome] clinical questions, conducting a literature review (over 10,000 articles reviewed with 63 references selected) and evaluating the evidence using the GRADE (grading of recommendations assessment, development and evaluation) process.
Dr. Sammaritano
“Recommendations were listed as strong or conditional, based on the level of evidence and certainty that benefits outweigh harms,” Dr. Sammaritano said. “There was also input from a patient panel discussion.”
Some limitations in scope included not addressing recommendations for diagnosis of SLE or broader, less well-understood issues, such as type 2 SLE, mental health and SLE-associated comorbidities, including bone health, cardiovascular disease or malignancy screening.
“For glucocorticoids, we urge prompt use to obtain rapid control of inflammation using the lowest dose for the shortest duration, and tapering as soon as possible to limit toxicity,” Dr. Sammaritano stated.
Dosages for hydroxychloroquine (HCQ) were also discussed. “All patients should be treated with hydroxychloroquine, unless contraindicated, and continued indefinitely even if in sustained remission,” Dr. Sammaritano said. Although the long-term goal is to maintain a daily dose of less than or equal to 5 mg/kg, the guideline notes short courses of higher doses of hydroxychloroquine (5–6.5 mg/kg/day) may be necessary at initiation of treatment to maintain disease control or during pregnancy.
All organ-specific recommendations were noted to be conditional.
Treating Lupus Serositis
Dr. Duarte-Garcia
Ali Duarte-Garcia, MD, MSc, assistant professor of medicine at the Mayo Clinic College of Medicine and Science, Rochester, Minn., discussed how to apply the guideline to treat lupus serositis. Lupus serositis refers to inflammation of serosal membranes, including pleuritis and pericarditis. Up to 43% of patients experience pleuritis during their disease course.2
