Semaglutide/ Obesity/ Prediabetes/ Clinical Practice Guidelines or Systemic Review

• Journal List
• RMD Open up
• v.4(Suppl 1); 2018
• PMC6269635

RMD Open up. 2018; iv(Suppl i): e000793.

Review

Systemic lupus erythematosus: land of the fine art on clinical practice guidelines

, ^ane Laurent Arnaud,² Rosaria Talarico,³ Carlo Alberto Scirè,^four Tobias Alexander,^v Zahir Amoura,^half-dozen Tadej Avcin,⁷ Alessandra Bortoluzzi,⁴ Ricard Cervera,^viii Fabrizio Conti,⁹ Alain Cornet,¹⁰ Hervé Devilliers,¹¹ Andrea Doria,¹² Micol Frassi,¹³ Micaela Fredi,¹³ Marcello Govoni,⁴ Frederic Houssiau,^ane Ana Lladò,^xiv Carla Macieira,^xv Thierry Martin,¹⁶ Laura Massaro,⁹ Maria Francisca Moraes-Fontes,¹⁴ Cristina Pamfil,¹⁶ Sabrina Paolino,¹⁷ Chiara Tani,^xviii Sander W Tas,^{nineteen, 20} Maria Tektonidou,²¹ Angela Tincani,¹³ Ronald F Van Vollenhoven,²² Stefano Bombardieri,²³ Gerd Burmester,⁵ João Eurico Fonseca,¹⁵ Ilaria Galetti,²⁴ Eric Hachulla,²⁵ Ulf Mueller-Ladner,²⁶ Matthias Schneider,²⁷ Vanessa Smith,²⁸ Maurizio Cutolo,¹⁷ Marta Mosca,^{18, 29} and Nathalie Costedoat-Chalumeau ^{thirty, 31, 32}

Farah Tamirou

ⁱ Rheumatology Department, Cliniques universitaires Saint-Luc, Université catholique deLouvain, Bruxelles, Belgium,

Laurent Arnaud

² Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Heart National de Referencedes Maladies Automobile-immunes et Systémiques Rares RESO, Strasbourg, France,

Rosaria Talarico

^three Rheumatology Unit of measurement, AOU Pisana, Pisa, Italia,

Carlo Alberto Scirè

⁴ Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italian republic,

Tobias Alexander

^five Section of Rheumatology and Clinical Immunology, Charité – Academy Medicine Berlin, Berlin, Germany,

Zahir Amoura

⁶ Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France,

Tadej Avcin

⁷ Department of Allergology, Rheumatology and Clinical Immunology, University Children'sHospital, University Medical Centre Ljubljana, Ljubljana, Slovenia,

Alessandra Bortoluzzi

⁴ Section of Rheumatology, Section of Medical Sciences, University of Ferrara, Ferrara, Italian republic,

Ricard Cervera

⁸ Section of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain,

Fabrizio Conti

⁹ Rheumatology Unit of measurement, Dipartimento di Medicina Interna e Specialità Mediche, Università degliStudi di Roma La Sapienza, Rome, Italia,

Alain Cornet

¹⁰ Lupus Europe, Brussels, Belgium,

Hervé Devilliers

¹¹ Department of Internal Medicine and Systemic Diseases, François-Mitterrand Educational activity Infirmary, University of Bourgogne-Franche-Comté, Dijon, France,

Andrea Doria

¹² Rheumatology Unit, Department of Medicine, AO Padova and University of Padua, Padua, Italy,

Micol Frassi

¹³ Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy,

Micaela Fredi

^thirteen Rheumatology and Clinical Immunology Unit, Ceremonious Hospital, Brescia, Italy,

Marcello Govoni

⁴ Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italia,

Frederic Houssiau

¹ Rheumatology Section, Cliniques universitaires Saint-Luc, Université catholique deLouvain, Bruxelles, Kingdom of belgium,

Ana Lladò

^xiv Unidade de Doenças Auto-imunes/Medicina 7.2, Hospital de Curry Cabral, Centro Hospitalarde Lisboa Primal, Lisbon, Portugal,

Carla Macieira

^xv Rheumatology Section, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Bookish Medical Centre, Lisbon, Portugal,

Thierry Martin

¹⁶ Section of Rheumatology, Emergency County Instruction Hospital, Cluj-Napoca, Romania,

Laura Massaro

⁹ Rheumatology Unit, Dipartimento di Medicina Interna due east Specialità Mediche, Università degliStudi di Roma La Sapienza, Rome, Italia,

Maria Francisca Moraes-Fontes

¹⁴ Unidade de Doenças Machine-imunes/Medicina 7.2, Infirmary de Back-scratch Cabral, Centro Hospitalarde Lisboa Central, Lisbon, Portugal,

Cristina Pamfil

¹⁶ Section of Rheumatology, Emergency Canton Teaching Hospital, Cluj-Napoca, Romania,

Sabrina Paolino

¹⁷ Research Laboratory and Academic Partitioning of Clinical Rheumatology, Section of Internal Medicine, IRCCS Polyclinic Hospital San Martino, Academy of Genoa, Genoa, Italian republic,

Chiara Tani

^eighteen Rheumatology Unit, AOU Pisana, Pisa, Italy,

Sander W Tas

¹⁹ Amsterdam UMC, Department of Clinical Immunology & Rheumatology and Department of Experimental Immunology, Amsterdam Infection and Immunity Establish, Meibergdreef 9, University of Amsterdam, Amsterdam, The netherlands,

²⁰ Amsterdam Rheumatology & immunology Eye (ARC), Bookish Medical Center, Amsterdam, Kingdom of the netherlands,

Maria Tektonidou

²¹ Joint Rheumatology Academic Program, First Section of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece,

Angela Tincani

¹³ Rheumatology and Clinical Immunology Unit of measurement, Civil Hospital, Brescia, Italy,

Ronald F Van Vollenhoven

²² Clinical Immunology & Rheumatology, Amsterdam Rheumatology & Immunology Center, Academic Medical Centre/University of Amsterdam, Amsterdam, Holland,

Stefano Bombardieri

²³ Academy of Pisa, Pisa, Italy,

Gerd Burmester

⁵ Section of Rheumatology and Clinical Immunology, Charité – University Medicine Berlin, Berlin, Germany,

João Eurico Fonseca

¹⁵ Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Heart, Lisbon, Portugal,

Ilaria Galetti

²⁴ FESCA - Federation of European Scleroderma Association, Milan, Italy,

Eric Hachulla

²⁵ Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Machine-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France,

Ulf Mueller-Ladner

²⁶ Section of Rheumatology and Clinical Immunology, Kerckhoff Clinic, Bad Nauheim, Germany,

Matthias Schneider

²⁷ Section of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany,

Vanessa Smith

²⁸ Department of Rheumatology, Department of Internal Medicine, Ghent University Infirmary, Ghent University, Ghent, Belgium,

Maurizio Cutolo

¹⁷ Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italian republic,

Marta Mosca

¹⁸ Rheumatology Unit, AOU Pisana, Pisa, Italian republic,

²⁹ Rheumatology Unit, University of Pisa, Pisa, Italy,

Nathalie Costedoat-Chalumeau

³⁰ Help Publique-Hôpitaux de Paris (AP-HP), Internal Medicine Department, Cochin Hospital, Referral middle for rare autoimmune and systemic diseases, Paris, France,

³¹ Paris Descartes Sorbonne, Paris Cité University, Paris, French republic,

³² INSERM U 1153, Heart for Epidemiology andStatistics Sorbonne Paris Cité (CRESS), Paris, France,

Received 2018 Aug vi; Revised 2018 October 5; Accepted 2018 October 8.

Abstract

Systemic lupus erythematosus (SLE) is the paradigm of systemic autoimmune diseases characterised by a wide spectrum of clinical manifestations with an unpredictable relapsing-remitting course. The aim of the present work was to identify electric current available clinical practice guidelines (CPGs) for SLE, to provide their review and to identify physicians' and patients' unmet needs. Twenty-iii original guidelines published between 2004 and 2017 were identified. Many aspects of illness management are covered, including global disease management, lupus nephritis and neuropsychiatric involvement, management of pregnancies, vaccinations and comorbidities monitoring. Unmet needs chronicle with affliction direction of some clinical manifestations and adherence to treatment. Many patient's unmet needs take been identified starting with faster diagnosis, demand for more therapeutic options, guidelines on lifestyle bug, attending to quality of life and adequate education.

Key letters

What is already known almost this subject area?

• Systemic lupus erythematosus (SLE) is the paradigm of systemic autoimmune diseases characterised by a wide spectrum of clinical manifestations with an unpredictable relapsing-remitting grade.

• A good number of Clinical Do Guidelines are currently available on SLE.

What does this study add?

• This review represents a land of the art on existing Clinical Do Guidelines and unmet needs in SLE.

How might this impact on clinical practice?

• In the framework of the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET), clinicians and patients will collaborate closely to address the unmet needs identified with the aim of harmonising the careprovided to SLE patients.

Introduction

Systemic lupus erythematosus (SLE) is the prototype of systemic autoimmune diseases characterised by a broad spectrum of clinical manifestations with an unpredictable relapsing-remitting course. While paediatric cases are described, SLE typically affects women between 16 years and 55 years. It is a heterogeneous condition, which may involve almost all organs and tissues. Some of the most common clinical features are mucocutaneous lesions, arthritis, renal interest, haematological disorders, serositis and fever. Forty per cent to lxx% of SLE patients suffer from lupus nephritis (LN) whose ascendant feature is proteinuria normally associated with urinary sediment abnormalities. Betwixt 10% and 20% of patients with LN will develop chronic renal failure. Neuropsychiatric manifestations can as well occur such as severe headache, seizure disorder, psychosis, acute confusional country and cognitive dysfunction. A higher charge per unit of mortality and morbidity is associated with renal and neuropsychiatric involvements. The serological pic of SLE is characterised past the positivity of many autoantibodies amidst which the virtually specific are anti-dsDNA and anti-Sm. The presence of antiphospholipid antibodies is associated with a worse prognosis. During the grade of SLE, patients may accrue both illness-related and treatment-related impairment. Although better apply of available therapies has greatly improved effect, SLE is still associated with a significant morbidity. In view of the large amount of specialists potentially involved in the daily care of SLE patients, also as the various therapeutic approaches, it is important to establish a commonly shared treatment strategy. Clinical practise guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances.¹ CPGs have been proposed for SLE, but they are sparse and not homogeneous. This manuscript intended is aimed at identifying current bachelor CPGs for SLE and physician's and patients' unmet needs.

Methods

ERN Rare CONnective tissue and musculoskeletal diseases NETwork (ReCONNET) SLE core set network

ERN ReCONNET is a European Reference Network funded by the European Marriage's Health Program to promote better and safer healthcare, define proper organisational assessment and identify standard and cost-effective pathways for the management of Rare and Complex Connective Tissue Diseases. The network includes rheumatologists (adult and paediatric), internists and immunologists from 26 selected centres in eight unlike countries across Europe.

Within the ERN ReCONNET, the SLE cadre ready network is composed of the members of the network involved in SLE, of FT and NC-C (the official SLE Disease Coordinators, inferior and senior) and of two methodologists of the ERN ReCONNET.

The SLE core fix network is addressed to focus on the management of all forms of SLE disease manifestations, including rare and complex weather condition.

One of the showtime core set network targets was to identify the currently available CPGs pertaining to SLE, in club to identify potential unmet needs, which should be further focused on. A literature search included all the papers published until July 2017. Analysis was conducted between June 2017 and February 2018. Planning and evaluation of the work was driven by regular interactions between participants of the working group during meetings (European League Against Rheumatism - EULAR congress 2017, American College of Rheumatology -ACR congress 2017, ERN ReCONNET coming together in Pisa, iv-6 of February 2018), web conferences, emails and the ERN Collaborative Platform (https://webgate.ec.europa.eu).

Systematic literature search

We carried out a systematic search in PubMed and Embase based on controlled terms (MeSH and Emtree) and keywords and on publication type (CPGs), in order to identify existing CPGs on diagnosis, monitoring and treatment, co-ordinate to the Institute of Medicine 2011 definition: clinical exercise guidelines are statements that include recommendations intended to optimise patient care that are informed past a systematic review of prove and an assessment of the benefits and harms of culling care options.

The search strategy is: MEDLINE (PubMed): ('lupus erythematosus, systemic'[MeSH Terms] OR ('lupus'[All Fields] AND 'erythematosus'[All Fields] AND 'systemic'[All Fields]) OR 'systemic lupus erythematosus'[All Fields] OR ('systemic'[All Fields] AND 'lupus'[All Fields] AND 'erythematosus'[All Fields])) AND ('Practise Guideline'[Publication Type] OR 'Practice Guidelines As Topic'[MeSH Terms] OR Practise Guideline [Publication Type] OR 'Practice Guideline'[Text Word] OR 'Practise Guidelines'[Text Discussion] OR 'Guideline'[Publication Type] OR 'Guidelines Equally Topic'[MeSH Terms] OR Guideline[Publication Type] OR 'Guideline'[Text Word] OR 'Guidelines'[Text Word] OR 'Consensus Development Briefing'[Publication Type] OR 'Consensus Development Conferences As Topic'[MeSH Terms] OR 'Consensus'[MeSH Terms] OR 'Consensus'[Text Word] OR 'Recommendation'[Text Word] OR 'Recommendations'[Text Give-and-take] OR 'Best Practice'[Text Word] OR 'Best Practices'[Text Give-and-take]). Embase: ('lupus erythematosus'/exp OR 'chronic lupus erythematosus' OR 'lupus erythematodes' OR 'lupus erythematosus' OR 'lupus erythematosus' OR 'lupus erythematosus handling' OR 'lupus syndrome') AND ('practise guideline'/exp OR 'practice guideline' OR 'practice guidelines'/exp OR 'exercise guidelines' OR 'clinical practice guideline'/exp OR 'clinical practice guideline' OR 'clinical practice guidelines'/exp OR 'clinical exercise guidelines' OR 'clinical practice guidelines as topic'/exp OR 'clinical do guidelines equally topic' OR 'guideline'/exp OR 'guideline' OR 'guidelines'/exp OR 'guidelines' OR 'guidelines every bit topic'/exp OR 'guidelines as topic' OR 'consensus evolution'/exp OR 'consensus development' OR 'consensus development conference'/exp OR 'consensus development conference' OR 'consensus evolution conferences'/exp OR 'consensus development conferences' OR 'consensus development conferences every bit topic'/exp OR 'consensus development conferences as topic' OR 'consensus'/exp OR 'consensus' OR 'recommendation' OR 'recommendations') AND [embase]/lim NOT [medline]/lim.

In lodge to implement the list of guidelines provided past MEDLINE and Embase search, the group besides performed a paw search.

Methodology of CPGs identification

All references included in the concluding list (systematic search+manus search) identified during the systematic literature search were screened for eligibility by 2 evaluators, the Illness Coordinators (NC-C and FT) of the ERN ReCONNET for SLE, based on championship and abstruse cess. Nosotros addressed the following question: does this paper describe CPG? Manuscripts scored equally such by at to the lowest degree one of the two evaluators were included in the next step.

The two evaluators then assessed all selected references with the full article in order to confirm that they were CPGs. In example of no agreement, a farther round of give-and-take involving a third evaluator (LA) was performed, in guild to reach consensus.

A discussion group was set up to confirm inclusion and evaluation of the selected CPGs. The topics covered by each guideline were systematically evaluated by 1 member of the grouping (FF) in order to guide the discussion group during the identification of the unmet needs. Physician'south unmet needs were then defined by the grouping, each participant giving his thoughts regarding what is non currently addressed by the electric current guidelines.

Finally, the patient's unmet needs paragraph intends to highlight the unmet needs of the European lupus community. The content of this paragraph has been realised by the ERN ReCONNET European Patient Advancement Group that advisedly collected the voices and the points of view of the whole European customs of the disease they stand for past means of meetings and web conferences.

Results

Land of the art on CPGs

Identification of existing CpGs

The systematic literature search yielded a total of 2272 citations. Title and abstract evaluation identified 52 papers suitable for full-text review. After total-text review, 21 original guidelines were identified^two–23 (figure 1figure i. Of notation, Saavedra et al published one guideline, which is divided into two parts with two different references, only this guideline was counted as one in the systematic search.^{fifteen 16} Two articles were included by hand search,^{24 25} leading to a total of 23 CPGs.

Flowchart constructed from Pubmed, Embase, and national databases.

The general characteristics of the 23 CPGs are summarised in tabular array i. 20-one were in English (including one in both English and Portuguese⁸) and two in French. Sixteen guidelines had been endorsed/supported by an official society or system: European League Against Rheumatism (EULAR) (n=8), American College of Rheumatology (ACR) (north=3), Brazilian Society of Rheumatology (northward=ane), European Matrimony (SHARE initiative) (due north=two), Mexican College of Rheumatology (northward=1) and Italian Society of Laboratory Medicine (n=1). The guidelines were published betwixt 2004 and 2017 with just four published before 2010.

Table i

CPGs general characteristics

Author	Endorsement by	Langage other than English	Date	Target	Scope	Patients' representatives
Andreoli et al 2	EULAR		2017	Women with SLE	Family unit planning, pregnancy, menopause in SLE and APS.	Yes (n=two)
Arnaud et al 3	/	French	2015	All patients with SLE	Cardiovascular risk management in SLE.	No
Benito-Garcia et al 4	ACR		2004	Patients with rheumatic diseases	Immunological laboratory testing.	No
Bertsias et al v	EULAR		2008	All patients with SLE	General direction of SLE.	No
Bertsias et al 6	EULAR		2010	All patients with SLE	Neuropsychiatric disease.	Aye (northward=1)
Bertsias et al 7	EULAR		2012	All patients with SLE	Renal affliction.	Yes (n=1)
Braz et al 8	Brazilian Gild of Rheumatology	English language and Portuguese	2015	Patients with autoimmune rheumatic diseases	Diagnosisand handling ofintestinal parasitic infections.	No
Goodman et al ix	ACR		2017	Patients with rheumatic diseases	Perioperative direction of antirheumatic medication inpatients undergoing elective total hip or full human knee arthroplasty.	Yes (patients' panel)
Groot et al x	European union (SHARE initiative)		2017	Juvenile SLE	Full general direction of babyhood-onset SLE.	No
Hahn et al eleven	ACR		2012	All patients with SLE	Renal disease.	No
Heijstek et al 12	EULAR		2011	Pediatric patients with rheumatic diseases	Vaccinations.	No
Mathian et al 13	/	French	2016	All patients with SLE	Prevention of infections.	No
Mosca et al 14	EULAR		2010	All patients with SLE	General management of SLE.	No
Savreeda Salinas role ane15 and ii16	Mexican College of Rheumatology		2015	Women with autoimmune rheumatic diseases	Management of pregnancy.	No
Silva et al 17	/		2009	Childrenand adolescents with rheumatic diseases	Vaccinations.	No
Tessier-Cloutier et al 18	/		2015	All patients with SLE	Monitoring of malignancies.	No
Tozzoli, et al xix	Italian Order of Laboratory Medicine		2002	Autoimmunerheumatic diseases	Laboratory utilise of autoantibody tests.	No
Trujillo-Martin, et al twenty	/		2016	All SLE patients	General management.	Yeah (due north=1)
Tselios, et al 21	/		2015	All SLE patients	Cardiovascular risk management.	No
VanVollenhoven, et al 22	EULAR		2014	All SLE patients	General direction (treat to target).	Yeah (n=ane)
Yuen23	/		2014	All SLE patients	Fatigue.	No
Groot, et al 24	Eu (SHARE initiative)		2017	Juvenile SLE with renal involvement	Direction of childhood-onset SLE nephritis.	No
vanAssen, et al 25	EULAR		2011	Rheumatic diseases	Vaccinations.	No

Five CPGs involved patient representatives and i involved a patient panel. Xv CPGs were dedicated to SLE, while viii covered a broader spectrum of rheumatic diseases (including SLE). Seventeen targeted all patients (juvenile and adult), four papers specifically targeted juvenile SLE and two female SLE. Five CPGs addressed general management of SLE, v addressed prevention or treatment of infections (3 specifically focusing on vaccination), iv focused on a specific SLE organ involvement (three on renal disease and one on neuropsychiatric disease) two addressed immunologic laboratory testing, while others focused on pregnancy and family planning (n=2), cardiovascular chance management (n=2), cancer (n=1), orthopaedic perioperative management (n=1) or fatigue (north=1).

Unmet needs

Clinicians' unmet needs

This review provides an overview of currently available CPGs for SLE. Yet, in that location are several areas that are not (yet) covered past guidelines.

The following items were considered equally correctly covered: (ane) global management of SLE,^{v 10 14 20 22} including a treat-to-target strategy²²; (2) autoantibodies testing^{iv 19}; (three) management of fatigue²³; (4) monitoring for malignancies¹⁸; Screening and management of cardiovascular risk factors^three and coronary illness risk monitoring²¹; (five) management (including treatment) of the two most astringent manifestations of SLE, namely lupus nephritis^{7 xi} (including in children²⁴) and neuropsychiatric interest⁶; (half dozen) prevention of infections¹³ with a focus on intestinal parasitic infections^viii; (seven) vaccination in adults,²⁵ in paediatric patients^{12 17} and in adolescents¹⁷; (8) pregnancy planning^{2 15 xvi} and management of menopause²; and (nine) Perioperative management for hip and articulatio genus surgery.⁹

Past contrast, several clinician'due south unmet needs were identified: (i) optimal management of serositis, gastrointestinal involvement, interstitial lung illness, retinal vasculitis, limited cutaneous disease, headaches and/or severe lymphopaenia that are not covered by the current available CPGs. (two) Evaluation and management of non-adherence to treatment is a crucial missing point which is only addressed by one available CPG.^ten (iii) Optimal duration of immunosuppression, which is only partly addressed in some guidelines. (four) Patient's input on CPGs is missing. Only one CPG proposed patient assessment equally a recommendation, which consisted in an evaluation of her/his quality of life past using a visual analogue calibration.¹⁴ (v) Except one CPG on LN,^eleven none of the available CPGs addressed the important question of ethnicity and its possible impact on disease severity. (six) No definition of photosensitivity and vasculitis is provided in current CPGs. (vii) No mention of non-health related prognostic determinants, such every bit patients' socioeconomic condition.

Patients' unmet needs

The first unmet need identified by patients deals with filibuster and incertitude in diagnosis until confirmation by a specialist. This adds to the psychological burden of the disease, which might be aggravated if treatment is delayed. The need for new treatment options, less reliant on steroids and associated with fewer side effects, is a high priority for patients. They advocate a more holistic disease management, going across specific symptoms or an 'organ by organ' management, to include a global treatment plan, coordinated past one dr., in casu a lupus expert, who treat them every bit a 'full person' and takes care, besides the clinical aspects, of the psychological bug. In our working group meetings, lupus patients defined handling as "whatever product or activity aiming at improving quality of life", clearly pinpointing the importance of a holistic approach. Patients are looking for scientifically validated patient focused guidelines on lifestyle issues. Research should be conducted jointly by HCPs and patient organisations to identify behaviours or actions that can help patients accept day-to-day ownership of their treatment, understanding what to do, or not to exercise, based on difficult data. Even if remission of SLE affliction activity has been accomplished, many patients notwithstanding face pain and fatigue. Agreement the drivers would permit edifice treatment guidelines for those conditions, which is disquisitional to avert that people facing these symptoms are pushed prematurely out of the labour market. Finally, while a huge amount of information is available to patients on the spider web, this information is of very low quality, often counterproductive and feet generating. There is a need for high-quality therapeutic patient education and for an efficacious way to fight fake news that spread over the internet, for example, by quality certified information, or improvidence of ERN-endorsed recommendations via social media posts.

Conclusions

Here we proposed an overview of the current available CPGs on SLE. Many unmet needs have been identified. Before long after we performed the systematic research, two clinical guidelines have been published.^{26 27} Gordon et al published the British guideline on SLE,²⁶ which proposed recommendations for some of these unmet needs, such as patient reported outcomes (Brusk Form (SF)-36 and Lupus QoL indices) and for immunosuppression duration. Pons-Estel et al ²⁷ published another guideline with a focus on socioeconomic and indigenous—namely in Latin Americans—aspects. Yet, many areas remain uncovered, and efforts are still needed to amend and standardise our daily practice.

Acknowledgments

Thanks to all the members of the Steering Committee of the ERN ReCONNET for the huge commitment during this work. A special thank goes to all the members of the ERN ReCONNET team for providing support during all the phases of the Piece of work Package 3.

Footnotes

Contributors: All authors contributed to the manuscript.

Funding: This publication was funded past the European Union'southward Health Programme (2014-2020).

Disclaimer: ERN ReCONNET is one of the 24 European Reference Networks (ERNs) approved by the ERN Lath of Member States. The ERNs are co-funded by the European Commission. The content of this publication represents the views of the authors only and information technology is their sole responsibleness; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) or any other body of the European Union. The European Commission and the Agency practice not have whatever responsibleness for use that may exist made of the information information technology contains.

Competing interests: None declared.

Patient consent: Non required.

Provenance and peer review: Deputed; externally peer reviewed.

Data sharing argument: No additional data are available.

References

1. Woolf SH, Grol R, Hutchinson A, et al. . Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ 1999;318:527–xxx. x.1136/bmj.318.7182.527 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

2. Andreoli L, Bertsias GK, Agmon-Levin N, et al. . EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis 2017;76:476–85. 10.1136/annrheumdis-2016-209770 [PMC complimentary article] [PubMed] [CrossRef] [Google Scholar]

3. Arnaud 50, Mathian A, Adoue D, et al. . [Screening and management of cardiovascular risk factors in systemic lupus erythematosus: Recommendations for clinical practice based on the literature and expert opinion]. Rev Med Interne 2015;36:372–fourscore. x.1016/j.revmed.2014.x.009 [PubMed] [CrossRef] [Google Scholar]

4. Benito-Garcia E, Schur PH, Lahita R, et al. . Guidelines for immunologic laboratory testing in the rheumatic diseases: anti-Sm and anti-RNP antibody tests. Arthritis Rheum 2004;51:1030–44. 10.1002/art.20836 [PubMed] [CrossRef] [Google Scholar]

5. Bertsias G, Ioannidis JP, Boletis J, et al. . EULAR recommendations for the management of systemic lupus erythematosus. Written report of a task force of the eular continuing committee for international clinical studies including therapeutics. Ann Rheum Dis 2008;67:195–205. 10.1136/ard.2007.070367 [PubMed] [CrossRef] [Google Scholar]

half dozen. Bertsias GK, Ioannidis JP, Aringer M, et al. . EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: study of a task force of the EULAR continuing committee for clinical affairs. Ann Rheum Dis 2010;69:2074–82. 10.1136/ard.2010.130476 [PubMed] [CrossRef] [Google Scholar]

7. Bertsias GK, Tektonidou K, Amoura Z, et al. . Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the direction of adult and paediatric lupus nephritis. Ann Rheum Dis 2012;71:1771–82. ten.1136/annrheumdis-2012-201940 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

eight. Braz AS, de Andrade CA, da Mota LM, et al. . [Recommendations from the Brazilian Society of Rheumatology on the diagnosis and treatment of intestinal parasitic infections in patients with autoimmune rheumatic disorders]. Rev Bras Reumatol 2015;55:368–80. 10.1016/j.rbr.2014.10.010 [PubMed] [CrossRef] [Google Scholar]

ix. Goodman SM, Springer B, Guyatt G, et al. . 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Constituent Total Hip or Total Articulatio genus Arthroplasty. Arthritis Rheumatol 2017;69:1538–51. x.1002/fine art.40149 [PubMed] [CrossRef] [Google Scholar]

ten. Groot N, de Graeff Northward, Avcin T, et al. . European evidence-based recommendations for diagnosis and handling of childhood-onset systemic lupus erythematosus: the SHARE initiative. Ann Rheum Dis 2017;76:1788–96. 10.1136/annrheumdis-2016-210960 [PubMed] [CrossRef] [Google Scholar]

11. Hahn BH, McMahon MA, Wilkinson A, et al. . American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Intendance Res 2012;64:797–808. 10.1002/acr.21664 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

12. Heijstek MW, Ott de Bruin LM, Bijl One thousand, et al. . EULAR recommendations for vaccination in paediatric patients with rheumatic diseases. Ann Rheum Dis 2011;70:1704–12. 10.1136/ard.2011.150193 [PubMed] [CrossRef] [Google Scholar]

13. Mathian A, Arnaud L, Adoue D, et al. . [Prevention of infections in adults and adolescents with systemic lupus erythematosus: Guidelines for the clinical practice based on the literature and practiced opinion]. Rev Med Interne 2016;37:307–20. x.1016/j.revmed.2016.01.005 [PubMed] [CrossRef] [Google Scholar]

fourteen. Mosca M, Tani C, Aringer Yard, et al. . European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies. Ann Rheum Dis 2010;69:1269–74. x.1136/ard.2009.117200 [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]

15. Saavedra Salinas MÁ, Barrera Cruz A, Cabral Castañeda AR, et al. . Clinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part I. Reumatol Clin 2015;11:295–304. 10.1016/j.reuma.2014.11.005 [PubMed] [CrossRef] [Google Scholar]

16. Saavedra Salinas MÁ, Barrera Cruz A, Cabral Castañeda AR, et al. . Clinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part II. Reumatol Clin 2015;11:305–15. x.1016/j.reuma.2014.12.004 [PubMed] [CrossRef] [Google Scholar]

17. Silva C, Terreri M, Barbosa C. Immunization consensus for children and adolescents with rheumatic diseases. Bras J Rheumatol 2009;49:562–89. [Google Scholar]

18. Tessier-Cloutier B, Clarke AE, Pineau CA, et al. . What investigations are needed to optimally monitor for malignancies in SLE? Lupus 2015;24:781–seven. 10.1177/0961203315575587 [PubMed] [CrossRef] [Google Scholar]

xix. Tozzoli R, Bizzaro N, Tonutti E, et al. . Guidelines for the laboratory use of autoantibody tests in the diagnosis and monitoring of autoimmune rheumatic diseases. Am J Clin Pathol 2002;117:316–24. 10.1309/Y5VF-C3DM-L8XV-U053 [PubMed] [CrossRef] [Google Scholar]

xx. Trujillo-Martín MM, Rúa-Figueroa Fernández de Larrinoa I, Ruíz-Irastorza Chiliad, et al. . [Clinical practice guidelines for systemic lupus erythematosus: Recommendations for full general clinical management]. Med Clin 2016;146:413.e1–413.e14. 10.1016/j.medcle.2016.06.033 [PubMed] [CrossRef] [Google Scholar]

21. Tselios K, Sheane BJ, Gladman DD, et al. . Optimal monitoring for coronary heart disease risk in patients with systemic lupus erythematosus: a systematic review. J Rheumatol 2016;43:54–65. 10.3899/jrheum.150460 [PubMed] [CrossRef] [Google Scholar]

22. van Vollenhoven RF, Mosca M, Bertsias One thousand, et al. . Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis 2014;73:958–67. ten.1136/annrheumdis-2013-205139 [PubMed] [CrossRef] [Google Scholar]

23. Yuen HK, Cunningham MA. Optimal management of fatigue in patients with systemic lupus erythematosus: a systematic review. Ther Clin Adventure Manag 2014;ten:775–86. 10.2147/TCRM.S56063 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

24. Groot N, de Graeff N, Marks SD, et al. . European prove-based recommendations for the diagnosis and treatment of babyhood-onset lupus nephritis: the SHARE initiative. Ann Rheum Dis 2017;76:1965–73. 10.1136/annrheumdis-2017-211898 [PubMed] [CrossRef] [Google Scholar]

25. van Assen South, Agmon-Levin N, Elkayam O, et al. . EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2011;70:414–22. 10.1136/ard.2010.137216 [PubMed] [CrossRef] [Google Scholar]

26. Gordon C, Amissah-Arthur MB, Gayed M, et al. . The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. Rheumatology 2018;57:e1–e45. 10.1093/rheumatology/kex286 [PubMed] [CrossRef] [Google Scholar]

27. Pons-Estel BA, Bonfa E, Soriano ER. First Latin American clinical practice guidelines for the handling of systemic lupus erythematosus: Latin American Grouping for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR). Ann Rheum Dis 2018. [PMC gratis commodity] [PubMed] [Google Scholar]

---

Articles from RMD Open are provided here courtesy of BMJ Publishing Group

---

glassharturch.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6269635/