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First UK guideline published for lupus management in adults

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The smallest effective dose of corticosteroids should be used to treat adult patients with lupus, according to the first ever UK guideline specifically for the management of the condition.

The first UK guideline on the care of adults with systemic lupus erythematosus – commonly known simply as lupus – has just been published by the British Society of Rheumatology.

“I would expect that patients will experience measurable improvements in care”

Caroline Gordon

The society said the guideline had been “eagerly anticipated” and would be “indispensable” to specialist nurses but would also be useful to others, such as those in accident and emergency.

The document covers diagnosis, assessment, monitoring and treatment of patients with mild, moderate and severe lupus and is mainly for health professionals in secondary care, said the society.

Its recommendations address care of those with common symptoms such as skin rashes and arthritis, as well as those with rarer but potentially more serious problems like kidney disease.

The guidance also covers routine monitoring and treatments that may reduce steroid use and second line approaches if there is a poor response to first choice treatment.

In addition, it promotes the referral of patients with the most serious and difficult-to-control disease to specialised lupus centres with experience of new therapies and multi-disciplinary team backup.

The society noted that lupus was associated with a significant risk of dying prematurely, reducing average lifespan by about 25 years, and that it affected nearly one in 1000 people in the UK.

Professor Caroline Gordon, a lupus expert and lead guideline author, said: “I would expect that patients will experience measurable improvements in care as a result of earlier diagnosis and more appropriate treatment.

“They can expect more rapid resolution of symptoms, reduction in disease flares and improvements in their quality of life, with fewer long term complications of the disease and its treatment – and, ultimately, improved survival,” she said.

Dr Elizabeth MacPhie, chair of the society’s standards, audit and guidelines working group, added: “Our guidelines are key to good care in rheumatological conditions.

“They firmly link the evidence base to clinical practice to help health professionals deliver the right care at the right time to the right patients – which might sound simple but can be a real challenge in a relapsing and remitting condition such as lupus,” she said.

The clinical guideline has been accredited by the National Institute for Health and Care Excellence and was published on 6 October 2017 in the journal Rheumatology.

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