The British Society for Rheumatology Guideline for the Management of Systemic Lupus Erythematosus in Adults

Caroline Gordon; Maame-Boatemaa Amissah-Arthur; Mary Gayed; Sue Brown; Ian N. Bruce; David D'Cruz; Benjamin Empson; Bridget Griffiths; David Jayne; Munther Khamashta; Liz Lightstone; Peter Norton; Yvonne Norton; Karen Schreiber; David Isenberg


Rheumatology. 2018;57(1):e1-e45. 

In This Article

Recommendations for the Management of Severe SLE

  1. Patients who present with severe SLE, including renal and NP manifestations, need thorough investigation to exclude other aetiologies, including infection (4/D). Treatment is dependent on the underlying aetiology (inflammatory and/or thrombotic), and patients should be treated accordingly with immunosuppression and/or anticoagulation, respectively (4/D) (SOA 98%).

  2. Immunosuppressive regimens for severe active SLE involve i.v. MP (2+/C) or high-dose oral prednisolone (up to 1 mg/kg/day) (4/D) to induce remission, either on their own or more often as part of a treatment protocol with another immunosuppressive drug (4/D) (SOA 98%).

  3. MMF or CYC are used for most cases of LN and for refractory, severe non-renal disease (2 ++/B) (SOA 98%).

  4. Biologic therapies belimumab (1+/B) or rituximab (2+/C) may be considered, on a case-by-case basis, where patients have failed to respond to other immunosuppressive drugs, due to inefficacy or intolerance (SOA 98%).

  5. IVIG (2−/D) and plasmapheresis (3/D) may be considered in patients with refractory cytopaenias, thrombotic thrombocytopaenic purpura (TTP) (1+/B), rapidly deteriorating acute confusional state and the catastrophic variant of APS (SOA 93%).