2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus

Lisa R. Sammaritano; Anca Askanase; Bonnie L. Bermas; Maria Dall'Era; Alí Duarte-García; Linda T. Hiraki; Mary Beth F. Son; Victoria P. Werth; Cynthia Aranow; April Barnado; Anna Broder; Hermine I. Brunner; Benjamin F. Chong; Vaidehi R. Chowdhary; Aimee O. Hersh; Peter M. Izmirly; Marimee Jules; Kenneth Kalunian; Diane Kamen; Tamar B. Rubinstein; Benjamin J. Smith; Natalie M. Smith; Asha Thomas; Homa Timlin; Daniel J. Wallace; Muayad Azzam; Christie M. Bartels; Joanne S. Cunha; Kimberly DeQuattro; Andrea Fava; Gabriel Figueroa-Parra; Shivani Garg; Lais Lopes Almeida Gomes; Maria C. Cuéllar-Gutiérrez; Priyanka Iyer; Andrew S. Johannemann; April Jorge; Shanthini Kasturi; Hassan Kawtharany; Jana Khawandi; Alexandra Legge; Kimberly P. Liang; Megan M. Lockwood; Alain Sanchez-Rodriguez; Marat Turgunbaev; Jessica N. Williams; Amy S. Turner; Reem A. Mustafa

doi:10.1002/art.43452

2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus

Lisa R. Sammaritano
, Anca Askanase
, Bonnie L. Bermas
, Maria Dall'Era
, Alí Duarte-García
, Linda T. Hiraki
, Mary Beth F. Son
, Victoria P. Werth
, Cynthia Aranow
, April Barnado
, Anna Broder
, Hermine I. Brunner
, Benjamin F. Chong
, Vaidehi R. Chowdhary
, Aimee O. Hersh
, Peter M. Izmirly
, Marimee Jules
, Kenneth Kalunian
, Diane Kamen
, Tamar B. Rubinstein

Benjamin J. Smith, Natalie M. Smith, Asha Thomas, Homa Timlin, Daniel J. Wallace, Muayad Azzam, Christie M. Bartels, Joanne S. Cunha, Kimberly DeQuattro, Andrea Fava, Gabriel Figueroa-Parra, Shivani Garg, Lais Lopes Almeida Gomes, Maria C. Cuéllar-Gutiérrez, Priyanka Iyer, Andrew S. Johannemann, April Jorge, Shanthini Kasturi, Hassan Kawtharany, Jana Khawandi, Alexandra Legge, Kimberly P. Liang, Megan M. Lockwood, Alain Sanchez-Rodriguez, Marat Turgunbaev, Jessica N. Williams, Amy S. Turner, Reem A. Mustafa

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Objective: To provide evidence-based and expert guidance for the treatment and management of non-renal systemic lupus erythematosus (SLE); treatment and management of lupus nephritis are addressed in a separate guideline. Methods: Clinical questions for treatment and management of SLE were developed in the PICO format (population, intervention, comparator, and outcome). Systematic literature reviews were developed for each PICO question, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess evidence quality and formulate recommendations. The Voting Panel achieved a consensus of ≥70% agreement on the direction (for or against) and strength (strong or conditional) of each recommendation. Results: We present recommendations and ungraded, consensus-based good practice statements for the treatment and management of SLE that are applicable to pediatric and adult patients. Recommendations emphasize uniform treatment with hydroxychloroquine, limiting duration of glucocorticoid use, and early introduction of conventional and/or biologic immunosuppressive therapies to achieve and maintain control of SLE inflammation (remission or a low level of disease activity), reduce SLE-related morbidity and mortality, and minimize medication-related toxicities. Conclusion: This guideline presents direction regarding treatment and management of SLE and provides a foundation for well-informed, shared clinician–patient decision-making. These recommendations should not be used to limit or deny access to therapies, as treatment decisions may vary due to the unique clinical situation and personal preferences of each person with SLE.

Original language	English
Journal	Arthritis and Rheumatology
DOIs	https://doi.org/10.1002/art.43452
State	Accepted/In press - 2025

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10.1002/art.43452

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Sammaritano, L. R., Askanase, A., Bermas, B. L., Dall'Era, M., Duarte-García, A., Hiraki, L. T., Son, M. B. F., Werth, V. P., Aranow, C., Barnado, A., Broder, A., Brunner, H. I., Chong, B. F., Chowdhary, V. R., Hersh, A. O., Izmirly, P. M., Jules, M., Kalunian, K., Kamen, D., ... Mustafa, R. A. (Accepted/In press). 2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus. Arthritis and Rheumatology. https://doi.org/10.1002/art.43452

@article{f63994375ffe4fed92e448281ec24219,

title = "2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus",

abstract = "Objective: To provide evidence-based and expert guidance for the treatment and management of non-renal systemic lupus erythematosus (SLE); treatment and management of lupus nephritis are addressed in a separate guideline. Methods: Clinical questions for treatment and management of SLE were developed in the PICO format (population, intervention, comparator, and outcome). Systematic literature reviews were developed for each PICO question, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess evidence quality and formulate recommendations. The Voting Panel achieved a consensus of ≥70\% agreement on the direction (for or against) and strength (strong or conditional) of each recommendation. Results: We present recommendations and ungraded, consensus-based good practice statements for the treatment and management of SLE that are applicable to pediatric and adult patients. Recommendations emphasize uniform treatment with hydroxychloroquine, limiting duration of glucocorticoid use, and early introduction of conventional and/or biologic immunosuppressive therapies to achieve and maintain control of SLE inflammation (remission or a low level of disease activity), reduce SLE-related morbidity and mortality, and minimize medication-related toxicities. Conclusion: This guideline presents direction regarding treatment and management of SLE and provides a foundation for well-informed, shared clinician–patient decision-making. These recommendations should not be used to limit or deny access to therapies, as treatment decisions may vary due to the unique clinical situation and personal preferences of each person with SLE.",

author = "Sammaritano, \{Lisa R.\} and Anca Askanase and Bermas, \{Bonnie L.\} and Maria Dall'Era and Al{\'i} Duarte-Garc{\'i}a and Hiraki, \{Linda T.\} and Son, \{Mary Beth F.\} and Werth, \{Victoria P.\} and Cynthia Aranow and April Barnado and Anna Broder and Brunner, \{Hermine I.\} and Chong, \{Benjamin F.\} and Chowdhary, \{Vaidehi R.\} and Hersh, \{Aimee O.\} and Izmirly, \{Peter M.\} and Marimee Jules and Kenneth Kalunian and Diane Kamen and Rubinstein, \{Tamar B.\} and Smith, \{Benjamin J.\} and Smith, \{Natalie M.\} and Asha Thomas and Homa Timlin and Wallace, \{Daniel J.\} and Muayad Azzam and Bartels, \{Christie M.\} and Cunha, \{Joanne S.\} and Kimberly DeQuattro and Andrea Fava and Gabriel Figueroa-Parra and Shivani Garg and Gomes, \{Lais Lopes Almeida\} and Cu{\'e}llar-Guti{\'e}rrez, \{Maria C.\} and Priyanka Iyer and Johannemann, \{Andrew S.\} and April Jorge and Shanthini Kasturi and Hassan Kawtharany and Jana Khawandi and Alexandra Legge and Liang, \{Kimberly P.\} and Lockwood, \{Megan M.\} and Alain Sanchez-Rodriguez and Marat Turgunbaev and Williams, \{Jessica N.\} and Turner, \{Amy S.\} and Mustafa, \{Reem A.\}",

note = "Publisher Copyright: {\textcopyright} 2025 American College of Rheumatology.",

year = "2025",

doi = "10.1002/art.43452",

language = "English",

journal = "Arthritis and Rheumatology",

issn = "2326-5191",

}

Sammaritano, LR, Askanase, A, Bermas, BL, Dall'Era, M, Duarte-García, A, Hiraki, LT, Son, MBF, Werth, VP, Aranow, C, Barnado, A, Broder, A, Brunner, HI, Chong, BF, Chowdhary, VR, Hersh, AO, Izmirly, PM, Jules, M, Kalunian, K, Kamen, D, Rubinstein, TB, Smith, BJ, Smith, NM, Thomas, A, Timlin, H, Wallace, DJ, Azzam, M, Bartels, CM, Cunha, JS, DeQuattro, K, Fava, A, Figueroa-Parra, G, Garg, S, Gomes, LLA, Cuéllar-Gutiérrez, MC, Iyer, P, Johannemann, AS, Jorge, A, Kasturi, S, Kawtharany, H, Khawandi, J, Legge, A, Liang, KP, Lockwood, MM, Sanchez-Rodriguez, A, Turgunbaev, M, Williams, JN, Turner, AS & Mustafa, RA 2025, '2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus', Arthritis and Rheumatology. https://doi.org/10.1002/art.43452

TY - JOUR

T1 - 2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus

AU - Sammaritano, Lisa R.

AU - Askanase, Anca

AU - Bermas, Bonnie L.

AU - Dall'Era, Maria

AU - Duarte-García, Alí

AU - Hiraki, Linda T.

AU - Son, Mary Beth F.

AU - Werth, Victoria P.

AU - Aranow, Cynthia

AU - Barnado, April

AU - Broder, Anna

AU - Brunner, Hermine I.

AU - Chong, Benjamin F.

AU - Chowdhary, Vaidehi R.

AU - Hersh, Aimee O.

AU - Izmirly, Peter M.

AU - Jules, Marimee

AU - Kalunian, Kenneth

AU - Kamen, Diane

AU - Rubinstein, Tamar B.

AU - Smith, Benjamin J.

AU - Smith, Natalie M.

AU - Thomas, Asha

AU - Timlin, Homa

AU - Wallace, Daniel J.

AU - Azzam, Muayad

AU - Bartels, Christie M.

AU - Cunha, Joanne S.

AU - DeQuattro, Kimberly

AU - Fava, Andrea

AU - Figueroa-Parra, Gabriel

AU - Garg, Shivani

AU - Gomes, Lais Lopes Almeida

AU - Cuéllar-Gutiérrez, Maria C.

AU - Iyer, Priyanka

AU - Johannemann, Andrew S.

AU - Jorge, April

AU - Kasturi, Shanthini

AU - Kawtharany, Hassan

AU - Khawandi, Jana

AU - Legge, Alexandra

AU - Liang, Kimberly P.

AU - Lockwood, Megan M.

AU - Sanchez-Rodriguez, Alain

AU - Turgunbaev, Marat

AU - Williams, Jessica N.

AU - Turner, Amy S.

AU - Mustafa, Reem A.

PY - 2025

Y1 - 2025

N2 - Objective: To provide evidence-based and expert guidance for the treatment and management of non-renal systemic lupus erythematosus (SLE); treatment and management of lupus nephritis are addressed in a separate guideline. Methods: Clinical questions for treatment and management of SLE were developed in the PICO format (population, intervention, comparator, and outcome). Systematic literature reviews were developed for each PICO question, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess evidence quality and formulate recommendations. The Voting Panel achieved a consensus of ≥70% agreement on the direction (for or against) and strength (strong or conditional) of each recommendation. Results: We present recommendations and ungraded, consensus-based good practice statements for the treatment and management of SLE that are applicable to pediatric and adult patients. Recommendations emphasize uniform treatment with hydroxychloroquine, limiting duration of glucocorticoid use, and early introduction of conventional and/or biologic immunosuppressive therapies to achieve and maintain control of SLE inflammation (remission or a low level of disease activity), reduce SLE-related morbidity and mortality, and minimize medication-related toxicities. Conclusion: This guideline presents direction regarding treatment and management of SLE and provides a foundation for well-informed, shared clinician–patient decision-making. These recommendations should not be used to limit or deny access to therapies, as treatment decisions may vary due to the unique clinical situation and personal preferences of each person with SLE.

AB - Objective: To provide evidence-based and expert guidance for the treatment and management of non-renal systemic lupus erythematosus (SLE); treatment and management of lupus nephritis are addressed in a separate guideline. Methods: Clinical questions for treatment and management of SLE were developed in the PICO format (population, intervention, comparator, and outcome). Systematic literature reviews were developed for each PICO question, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess evidence quality and formulate recommendations. The Voting Panel achieved a consensus of ≥70% agreement on the direction (for or against) and strength (strong or conditional) of each recommendation. Results: We present recommendations and ungraded, consensus-based good practice statements for the treatment and management of SLE that are applicable to pediatric and adult patients. Recommendations emphasize uniform treatment with hydroxychloroquine, limiting duration of glucocorticoid use, and early introduction of conventional and/or biologic immunosuppressive therapies to achieve and maintain control of SLE inflammation (remission or a low level of disease activity), reduce SLE-related morbidity and mortality, and minimize medication-related toxicities. Conclusion: This guideline presents direction regarding treatment and management of SLE and provides a foundation for well-informed, shared clinician–patient decision-making. These recommendations should not be used to limit or deny access to therapies, as treatment decisions may vary due to the unique clinical situation and personal preferences of each person with SLE.

UR - https://www.scopus.com/pages/publications/105021025888

U2 - 10.1002/art.43452

DO - 10.1002/art.43452

M3 - Article

C2 - 41187097

AN - SCOPUS:105021025888

SN - 2326-5191

JO - Arthritis and Rheumatology

JF - Arthritis and Rheumatology

ER -

2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus

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