Abstract | OBJECTIVE: METHODS: SLE experts (n = 69) were e-mailed scenarios and indicated preferred treatments. Algorithms were constructed and agreement determined (≥50% respondents indicating ≥70% agreement). RESULTS: Initially, 54% (n = 37) responded suggesting treatment for scenarios; 13 experts rated agreement with scenarios. Fourteen of 16 scenarios had agreement as follows: discoid lupus: first-line therapy was topical agents and hydroxychloroquine and/or glucocorticoids then azathioprine and subsequently mycophenolate (mofetil); uncomplicated cutaneous vasculitis: initial treatment was glucocorticoids ± hydroxychloroquine ± methotrexate, followed by azathioprine or mycophenolate and then cyclophosphamide; arthritis: initial therapy was hydroxychloroquine and/or glucocorticoids, then methotrexate and subsequently rituximab; pericarditis: first-line therapy was nonsteroidal antiinflammatory drugs, then glucocorticoids with/without hydroxychloroquine, then azathioprine, mycophenolate, or methotrexate and finally belimumab or rituximab, and/or a pericardial window; interstitial lung disease/alveolitis: induction was glucocorticoids and mycophenolate or cyclophosphamide, then rituximab or intravenous gamma globulin ( IVIG), and maintenance followed with azathioprine or mycophenolate; pulmonary hypertension: glucocorticoids and mycophenolate or cyclophosphamide and an endothelin receptor antagonist were initial therapies, subsequent treatments were phosphodiesterase-5 inhibitors and then prostanoids and rituximab; antiphospholipid antibody syndrome: standard anticoagulation with/without hydroxychloroquine, then a thrombin inhibitor for venous thrombosis, versus adding aspirin or platelet inhibition drugs for arterial events; mononeuritis multiplex and central nervous system vasculitis: first-line therapy was glucocorticoids and cyclophosphamide followed by maintenance with azathioprine or mycophenolate, and then rituximab, IVIG, or plasmapheresis; and serious lupus nephritis: first-line therapy was glucocorticoids and mycophenolate, then cyclophosphamide then rituximab. CONCLUSION: We established variable agreement on treatment approaches. For some treatment decisions there was good agreement between experts even if no randomized controlled trial data were available.
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Authors | Chayawee Muangchan, Ronald F van Vollenhoven, Sasha R Bernatsky, C Douglas Smith, Marie Hudson, Murat Inanç, Naomi F Rothfield, Peter T Nash, Richard A Furie, Jean-Luc Senécal, Vinod Chandran, Ruben Burgos-Vargas, Rosalind Ramsey-Goldman, Janet E Pope |
Journal | Arthritis care & research
(Arthritis Care Res (Hoboken))
Vol. 67
Issue 9
Pg. 1237-1245
(Sep 2015)
ISSN: 2151-4658 [Electronic] United States |
PMID | 25777803
(Publication Type: Journal Article)
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Copyright | © 2015, American College of Rheumatology. |
Topics |
- Aged
- Algorithms
- Female
- Humans
- Lupus Erythematosus, Systemic
(therapy)
- Male
- Middle Aged
- Practice Guidelines as Topic
- Surveys and Questionnaires
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