ACR Releases New Guideline for Management of SLE at ACR 2025

Data from post-hoc analyses of randomized, controlled trials of belimumab and anifrolumab were presented, demonstrating improvement in lupus arthritis.^4,7-12

Treating Childhood Onset Lupus

Dr. Hiraki

Linda Hiraki, MD, FRCPC, ScD, associate professor at The Hospital for Sick Children, Toronto, and Bonnie Bermas, MD, professor of medicine at University of Texas Southwestern at Dallas, presented on applying the ACR Guideline to children and adolescents with SLE.

“These guidelines were meant to be applicable for people with SLE across the lifespan and are not restricted to a specific age,” Dr. Hiraki said. “However, there are specific pediatric considerations.”

The guideline recommends that a pediatric rheumatologist should be consulted in pediatric SLE, when possible, especially in highly complex or acutely ill patients.

“Youth with childhood SLE should be monitored for delayed pubertal onset and growth velocity, due to disease activity and glucocorticoid treatment,” Dr. Hiraki said. “In addition to close monitoring and partnering with endocrinology when necessary, applying pediatric-specific glucocorticoid dosing is also recommended.”

Depression, anxiety and suicidal ideation are common among adolescents and young adults with cSLE, and should be considered in evaluating these patients.^13,14 The ACR Guidance Statements for Addressing Mental Health Concerns in Youth With Pediatric Rheumatologic Diseases can be a helpful resource to reference, Dr. Hiraki said.¹⁴

Transition to Adult Care

Dr. Bermas

A planned transition to adult care is recommended to decrease risks of unscheduled healthcare use, care gaps and disease flares, Dr. Hiraki explained.

“The transition to adult care should ideally start many years before the adolescent turns 18,” Dr. Bermas reiterated. This process includes assessing skills for transition readiness, conducting a self-care assessment, developing a transition plan and providing transfer documents, as well as communicating to the adult provider.¹⁵

Dr. Bermas noted the importance of adult rheumatologists to assess self-efficacy in patients transitioning to adult care, as well as address such concerns as fertility, contraception, bone health and mood.

Q&A

In the Q&A session, Dr. Sammaritano explained no specific recommendations provided for use of hydroxychloroquine levels, due to limited evidence and variable testing from institution to institution. This was noted to be an area of great interest, however, and was highlighted as a future research goal.

Another audience member asked about the use of tumor necrosis factor (TNF) inhibitor in SLE arthritis. “There are case series of use of TNFi in SLE arthritis, especially in cases with RA-like overlap or erosive disease,” Dr. Askanase said. “I think it makes sense to use in situations. However, there is a concern for possible exacerbation of lupus symptoms from TNF inhibitor therapy.”