Systemic lupus erythematosus
Also known as: lupus · lupus nephritis · SLE
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2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus
American College of Rheumatology (ACR) · 2025 · 2025 guideline
The ACR lupus guideline page, which hosts the 2025 guideline on treatment of systemic lupus erythematosus alongside the separate 2024 guideline on screening, treatment and management of lupus nephritis. Supporting materials include summaries, methodology appendices and a manuscript on patient values and preferences.
EULAR recommendations for the management of systemic lupus erythematosus: 2023 update
European Alliance of Associations for Rheumatology (EULAR) · 2024 · 2023 update
European recommendations on managing systemic lupus erythematosus, published in Annals of the Rheumatic Diseases. They address antimalarial and glucocorticoid use, immunosuppressive and biologic agents, organ-specific manifestations including renal, cutaneous, neuropsychiatric and haematological disease, and preventive care for infection, bone and cardiovascular risk.
- Comprises five overarching principles and 13 recommendations, developed by an internationally expanded task force. source
- Emphasises hydroxychloroquine for essentially all patients and minimising long-term glucocorticoid exposure. source
- Includes specific guidance for lupus nephritis and for SLE-associated antiphospholipid syndrome. source
US vs EU key differences
- The two converge on hydroxychloroquine: both recommend it for essentially all patients with SLE at a target dose of no more than 5 mg/kg per day to limit retinal toxicity. source
- Both also converge on steroid minimisation, setting a maintenance ceiling of 5 mg/day prednisone equivalent or less with withdrawal where feasible - the ACR frames it as tapering to that level within about six months. source
- Update cadence differs markedly: EULAR has refreshed its SLE recommendations roughly every four to five years (2019, then 2023), while the 2025 ACR document is the society's first full SLE treatment guideline in over two decades. source
- For active proliferative lupus nephritis the EULAR update names specific add-on regimens - belimumab, or a calcineurin inhibitor such as voclosporin or tacrolimus, layered onto mycophenolate or low-dose intravenous cyclophosphamide plus glucocorticoids. source
What changed recently
- EU2019 update → 2023 update2023-10-12
The acceptable maintenance prednisone ceiling was lowered from 7.5 mg/day to 5 mg/day, and the guidance now pushes earlier addition of immunosuppressants or a biologic for anyone not responding to hydroxychloroquine or unable to taper below that steroid dose. Anifrolumab was added alongside belimumab as an option, and combination regimens with belimumab or voclosporin were endorsed for lupus nephritis; the recommendations were condensed to 13.
source ↗curation confidence 90%
See the full update feed for changes across every system.