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)
Date
2018
Type:
Article
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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.
Description
Luis A González Naranjo , Yelitza C González Bello, María Victoria Collado, Judith Sarano, Soledad Retamozo, María E Sattler, Rocio V Gamboa-Cárdenas, Ernesto Cairoli, Silvana M Conti, Luis M Amezcua-Guerra, Luis H Silveira, Eduardo F Borba, Mariana A Pera, Paula B Alba Moreyra, Valeria Arturi, Guillermo A Berbotto, Cristian Gerling, Carla A Gobbi, Viviana L Gervasoni, Hugo R Scherbarth, João C Tavares Brenol, Fernando Cavalcanti, Lilian T Lavras Costallat, Nilzio A Da Silva, Odirlei A Monticielo, Luciana Parente Costa Seguro, Ricardo M Xavier, Carolina Llanos, Rubén A Montúfar Guardado, Ignacio Garcia de la Torre, Carlos Pineda, Margarita Portela Hernández, Alvaro Danza, Marlene Guibert-Toledano, Gil Llerena Reyes, Maria Isabel Acosta Colman Alicia M Aquino, Claudia S Mora-Trujillo, Roberto Muñoz-Louis, Ignacio García Valladares, María Celeste Orozco, Paula I Burgos, Graciela V Betancur, Graciela S Alarcón, Grupo Latino Americano de Estudio del Lupus (GLADEL) and Pan-American League of Associations of Rheumatology (PANLAR)
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Citation
Pons-Estel BA, Bonfa E, Soriano ER, Cardiel MH, Izcovich A, Popoff F, Criniti JM, Vásquez G, Massardo L, Duarte M, Barile-Fabris LA, García MA, Amigo MC, Espada G, Catoggio LJ, Sato EI, Levy RA, Acevedo Vásquez EM, Chacón-Díaz R, Galarza-Maldonado CM, Iglesias Gamarra AJ, Molina JF, Neira O, Silva CA, Vargas Peña A, Gómez-Puerta JA, Scolnik M, Pons-Estel GJ, Ugolini-Lopes MR, Savio V, Drenkard C, Alvarellos AJ, Ugarte-Gil MF, Babini A, Cavalcanti A, Cardoso Linhares FA, Haye Salinas MJ, Fuentes-Silva YJ, Montandon de Oliveira E Silva AC, Eraso Garnica RM, Herrera Uribe S, Gómez-Martín D, Robaina Sevrini R, Quintana RM, Gordon S, Fragoso-Loyo H, Rosario V, Saurit V, Appenzeller S, Dos Reis Neto ET, Cieza J, González Naranjo LA, González Bello YC, Collado MV, Sarano J, Retamozo S, Sattler ME, Gamboa-Cárdenas RV, Cairoli E, Conti SM, Amezcua-Guerra LM, Silveira LH, Borba EF, Pera MA, Alba Moreyra PB, Arturi V, Berbotto GA, Gerling C, Gobbi CA, Gervasoni VL, Scherbarth HR, Brenol JCT, Cavalcanti F, Costallat LTL, Da Silva NA, Monticielo OA, Seguro LPC, Xavier RM, Llanos C, Montúfar Guardado RA, Garcia de la Torre I, Pineda C, Portela Hernández M, Danza A, Guibert-Toledano M, Reyes GL, Acosta Colman MI, Aquino AM, Mora-Trujillo CS, Muñoz-Louis R, García Valladares I, Orozco MC, Burgos PI, Betancur GV, Alarcón GS; Grupo Latino Americano de Estudio del Lupus (GLADEL) and Pan-American League of Associations of Rheumatology (PANLAR). 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). Ann Rheum Dis. 2018 Nov;77(11):1549-1557. doi: 10.1136/annrheumdis-2018-213512.
Keywords
Lupus nephritis, Systemic lupus erythematosus, Treatment