First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)–Pan-American League of Associations of Rheumatology (PANLAR). Issue 11 (25th July 2018)

• Record Type: Journal Article
• Authors: Pons-Estel, Bernardo A; Bonfa, Eloisa; Soriano, Enrique R; Cardiel, Mario H; Izcovich, Ariel; Popoff, Federico; Criniti, Juan M; Vásquez, Gloria; Massardo, Loreto; Duarte, Margarita; Barile-Fabris, Leonor A; García, Mercedes A; Amigo, Mary-Carmen; Espada, Graciela; Catoggio, Luis J; Sato, Emilia Inoue; Levy, Roger A; Acevedo Vásquez, Eduardo M; Chacón-Díaz, Rosa; Galarza-Maldonado, Claudio M; Iglesias Gamarra, Antonio J; Molina, José Fernando; Neira, Oscar; Silva, Clóvis A; Vargas Peña, Andrea; Gómez-Puerta, José A; Scolnik, Marina; Pons-Estel, Guillermo J; Ugolini-Lopes, Michelle R; Savio, Verónica; Drenkard, Cristina; Alvarellos, Alejandro J; Ugarte-Gil, Manuel F; Babini, Alejandra; Cavalcanti, André; Cardoso Linhares, Fernanda Athayde; Haye Salinas, Maria Jezabel; Fuentes-Silva, Yurilis J; Montandon de Oliveira e Silva, Ana Carolina; Eraso Garnica, Ruth M; Herrera Uribe, Sebastián; Gómez-Martín, Diana; Robaina Sevrini, Ricardo; Quintana, Rosana M; Gordon, Sergio; Fragoso-Loyo, Hilda; Rosario, Violeta; Saurit, Verónica; Appenzeller, Simone; dos Reis Neto, Edgard Torres; Cieza, Jorge; González Naranjo, Luis A; González Bello, Yelitza C; Collado, María Victoria; Sarano, Judith; Retamozo, Soledad; Sattler, María E; Gamboa-Cárdenas, Rocio V; Cairoli, Ernesto; Conti, Silvana M; Amezcua-Guerra, Luis M; Silveira, Luis H; Borba, Eduardo F; Pera, Mariana A; Alba Moreyra, Paula B; Arturi, Valeria; Berbotto, Guillermo A; Gerling, Cristian; Gobbi, Carla A; Gervasoni, Viviana L; Scherbarth, Hugo R; Brenol, João C Tavares; Cavalcanti, Fernando; Costallat, Lilian T Lavras; Da Silva, Nilzio A; Monticielo, Odirlei A; Seguro, Luciana Parente Costa; Xavier, Ricardo M; Llanos, Carolina; Montúfar Guardado, Rubén A; Garcia de la Torre, Ignacio; Pineda, Carlos; Portela Hernández, Margarita; Danza, Alvaro; Guibert-Toledano, Marlene; Reyes, Gil Llerena; Acosta Colman, Maria Isabel; Aquino, Alicia M; Mora-Trujillo, Claudia S; Muñoz-Louis, Roberto; García Valladares, Ignacio; Orozco, María Celeste; Burgos, Paula I; Betancur, Graciela V; Alarcón, Graciela S;
• Is Part Of: Annals of the rheumatic diseases. Volume 77:Issue 11(2018)
• Page Start: 1549
• Page End: 1557
• Publication Date: 2018-07-25
• Subjects: systemic lupus erythematosus -- treatment -- lupus nephritis; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-213512
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.