UK releases first guideline on care and treatment of adults with lupus

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The UK’s first guideline on the care of adults with systemic lupus erythematosus (lupus) has been released guideline by the British Society of Rheumatology, and covers diagnosis, assessment, monitoring and treatment of patients with mild, moderate and severe lupus.

Lead guideline author Caroline Gordon, a lupus expert and professor of rheumatology at the University of Birmingham, said: “Lupus can affect any part of the body and can be difficult to diagnose and treat. It is more common than many people realise, has a major impact on the health and activities of individuals with the disease and it is associated with a significant risk of dying prematurely – reducing average lifespan by about 25 years.

“This guideline is essential because it provides advice on how to diagnose the condition and then how to assess the disease and determine what type of treatment will be most suitable, whether people have common manifestations such as skin rashes and arthritis, or less common but potentially more serious problems such as kidney disease.”

It is aimed at rheumatologists and clinical nurse specialists in lupus, as well as nephrologists, immunologists, dermatologists, emergency medicine practitioners and GPs.

Gordon adds: “As a result of this guideline I would expect that patients will experience measurable improvements in care. With earlier diagnosis and more appropriate treatment we should see more rapid resolution of symptoms, reduction in disease flares and improvements in the quality of life of patients, with less long-term complications of the disease and its treatment and improved survival rates.”

The guideline provides advice on how people should be monitored for evidence of improvement or deterioration, encourages the use of a variety of treatments to ensure less reliance on steroids to control symptoms and provides information on which drugs to use for people that do not respond to initial treatment plans.

Importantly, it also emphasises the need for people with the most serious and difficult to control forms of the disease to be referred to specialised lupus centres to access new therapies and multi-disciplinary teams.

It guides the care of patients with common symptoms such as skin rashes and arthritis as well as those with less common but potentially more serious problems like kidney disease.

Background
SLE (or lupus for short) is a multisystem, autoimmune disease, involving complex pathogenetic mechanisms that can present at any age. It most commonly presents in women in the reproductive age group, although lupus is increasingly recognized after the age of 40 years, particularly in Europeans [1–3]. Lupus affected nearly 1 in 1000 of the population in the UK in 2012 [4] and was most frequently observed in people of African-Caribbean and South Asian descent [4–6]. The age-standardized incidence in the UK according to the Clinical Practice Research Datalink is 8.3/100 000/year for females and 1.4/100 000/year for males [4], and the highest incidence rates are seen in those of African-Caribbean descent: 31.4/100 000/year, compared with 6.7/100 000/year for those of white European descent. The mean age at diagnosis is 48.9 years [4], but it is lower in those of African ancestry in the UK [4–6] and North America [2, 7]. NICE has accredited the process used by the BSR to produce its guidance on the management of systemic lupus erythematosus in adults. Accreditation is valid for 5 years from 10 June 2013.

Authors
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

University of Birmingham material
Rheumatology abstract


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