The DOI matches its Crossref record; 162 of the 162 references it cites were found in a registry or an index; 1 of the 43 sources its claims cite were checked for support.
2019 update of the EULAR recommendations for the management of systemic lupus erythematosus
Open accessAbstract
Our objective was to update the EULAR recommendations for the management of systemic lupus erythematosus (SLE), based on emerging new evidence. We performed a systematic literature review (01/2007–12/2017), followed by modified Delphi method, to form questions, elicit expert opinions and reach consensus. Treatment in SLE aims at remission or low disease activity and prevention of flares. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. During chronic maintenance treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn. Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can expedite the tapering/discontinuation of GC. In persistently active or flaring extrarenal disease, add-on belimumab should be considered; rituximab (RTX) may be considered in organ-threatening, refractory disease. Updated specific recommendations are also provided for cutaneous, neuropsychiatric, haematological and renal disease. Patients with SLE should be assessed for their antiphospholipid antibody status, infectious and cardiovascular diseases risk profile and preventative strategies be tailored accordingly. The updated recommendations provide physicians and patients with updated consensus guidance on the management of SLE, combining evidence-base and expert-opinion.
Overview
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Written from the paper’s full text.
TL;DR
This 2019 EULAR update provides consensus recommendations for managing systemic lupus erythematosus (SLE), based on a systematic literature review (2007–2017) and a Delphi process, yielding 33 final statements across goals of treatment, treatment, specific manifestations, and comorbidities. It emphasizes remission or low disease activity, hydroxychloroquine for all patients at ≤5 mg/kg real body weight, glucocorticoid minimization to <7.5 mg/day prednisone equivalent when possible, and add-on belimumab or rituximab in defined refractory settings.
Key findings
- The Task Force reached consensus on 33 final statements; treatment should aim at remission or low disease activity and prevention of flares. Hydroxychloroquine (HCQ) is recommended for all patients with SLE unless contraindicated, at a dose not exceeding 5 mg/kg real body weight, with ophthalmological screening at baseline, after 5 years, and yearly thereafter in the absence of retinal toxicity risk factors.
- For chronic maintenance, glucocorticoids should be minimized to less than 7.5 mg/day prednisone equivalent and withdrawn when possible; prompt initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can expedite tapering/discontinuation. Add-on belimumab should be considered in extrarenal disease with inadequate response to standard care, and rituximab may be considered in organ-threatening, refractory disease.
- In lupus nephritis, mycophenolate or low-dose intravenous cyclophosphamide are recommended for induction, and mycophenolate or azathioprine for maintenance; high-dose intravenous cyclophosphamide can also be used in patients at high risk for renal failure. Calcineurin inhibitors may be considered as second-line agents mainly in membranous lupus nephritis, podocytopathy, or refractory nephrotic syndrome.
- All patients with SLE should be screened at diagnosis for antiphospholipid antibodies; infection and cardiovascular disease risk should be assessed and preventative strategies tailored. Low-dose aspirin may be considered for primary cardiovascular prevention (HR 0.24 in one retrospective study), but this must be balanced against bleeding hazard; routine statins are not recommended for all patients.
Methods
- After EULAR Executive Committee approval, a Task Force performed an update using EULAR standardised operating procedures and AGREE II. A systematic literature review screened PubMed for English-language publications from 01/2007 to 12/2017, with two exceptions: skin disease had an unrestricted date search, and renal disease was limited to 01/2012–12/2017.
- Fourteen research questions were selected via Delphi methodology; pertinent articles from manual reference-list searches were also included. Evidence was categorised by study design and validity, statements were graded, and after discussion rounds the committee reached consensus on 33 final statements, with each Task Force member rating agreement.
Limitations
- The paper states several evidence gaps: data on optimal duration and timing of therapy discontinuation in renal and extrarenal disease are scarce; calcineurin inhibitor studies in lupus nephritis were performed almost exclusively in Asian populations and had short follow-up; no studies have been performed exclusively in patients with SLE-antiphospholipid syndrome; and no formal studies address low-molecular-weight heparin during high-risk periods. It also notes that HCQ efficacy was established at 6.5 mg/kg/day, so whether a lower dose has comparable clinical effects remains to be confirmed, and data are insufficient to recommend routine drug-level monitoring.
- Evident from the text: the recommendations combine evidence and expert opinion, with many statements supported by low evidence grades (e.g., 4/C, 2b/C) and consensus agreement rather than high-quality randomized evidence. The systematic review ended in 12/2017, so later evidence is not incorporated.
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Claims the paper makes
44 Not checked yet · 6 Own interpretation · 5 Own method · 1 Partly supported · accuracy not yet measured
In the paper
“In monitoring renal response, reduction of UPr (to less than 0.8 g/day) following treatment is more important than residual haematuria.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Goals of treatment
What the sources say
- Not checked yetcites [21] Dall'Era, 2015, Predictors of long-term renal outcome in lupus nephritis trials: lessons learned from the Euro-Lupus nephritis cohort, Arthritis Rheumatol source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“a prevalence of retinal abnormalities exceeding 10% after 20 years of continuous use.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Treatment of SLE Hydroxychloroquine
What the sources say
- Not checked yetcites 36 37
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Complete remission (absence of clinical activity with no use of GC and IS drugs) is infrequent.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Goals of treatment
What the sources say
- Not checked yetcites [12][13][14][15][16]
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“newly defined low disease activity states (based on a SLEDAI score ≤3 on antimalarials, or alternatively SLEDAI ≤4, PGA≤1 with GC ≤7.5 mg of prednisone and well tolerated IS agents) have shown comparable rates with remission, regarding halting of damage accrual (OR 0.5-0.7 for increase in damage index) and prevention of flares.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Goals of treatment
What the sources say
- Not checked yetcites 14 17-20
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“a posthoc analysis of the LUNAR trial showed that complete B-cell depletion following RTX treatment in LN was associated with higher odds for complete response at 78 weeks.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Biological agents
What the sources say
- Not checked yetcites [78] Gomez Mendez, 2018, Peripheral blood B cell depletion after rituximab and complete response in lupus nephritis, Clin J Am Soc Nephrol source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Published data support the use of MMF and high-dose CYC (online supplementary table 5) in severe forms of LN associated with increased risk of progression into end-stage renal disease”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Renal disease
What the sources say
- Not checked yetcites 118 119
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Drug blood levels can be used to assess compliance”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Treatment of SLE Hydroxychloroquine
What the sources say
- Not checked yetcites 33 35
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“longterm GC therapy can have various detrimental effects including irreversible organ damage.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Glucocorticoids
What the sources say
- Not checked yetcites [38][39][40][41]
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Consistently reported risk factors for a higher disease flare rate include younger age at disease onset, no use of antimalarials, persistent generalised disease activity and serological activity (anti-dsDNA, low complement).”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Goals of treatment
What the sources say
- Not checked yetcites [27][28][29][30][31]
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Concomitant use of GnRH analogues attenuates the depletion of ovarian reserve associated with CYC therapy”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Immunosuppressive (IS) drugs
What the sources say
- Not checked yetcites 4 58 59
plaindirect- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 21
- Probably not a substantial claim. 9
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Treatment of thrombocytopenia is typically lengthy and often characterised by relapses during GC tapering.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Haematological disease
What the sources say
- Partly supportedcites [109] Jung, 2016, Thrombocytopenia in systemic lupus erythematosus: clinical manifestations, treatment, and prognosis in 230 patients, Medicine sourceExperimental — accuracy not yet measured
The Results report relapses in patients with SLE-associated thrombocytopenia, and the Discussion says some patients require continuous moderate doses of glucocorticoids. Neither section establishes that treatment is typically lengthy or that relapses occur specifically during glucocorticoid tapering. Page numbers are unavailable in our copy. (LLM, conf=0.84)
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Partly supported
In the paper
“Risks are substantially increased at continuous GC doses above 7.5 mg/day, with some studies suggesting that also lower doses might be harmful.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Glucocorticoids
What the sources say
- Not checked yetcites 17 42-44
hedgeddirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Consequent initiation of IS drugs facilitates a more rapid GC tapering and may prevent disease flares.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Immunosuppressive (IS) drugs
What the sources say
- Not checked yetcites [49] Pego-Reigosa, 2013, Efficacy and safety of nonbiologic immunosuppressants in the treatment of nonrenal systemic lupus erythematosus: a systematic review, Arthritis Care Res source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“Distinction between the two pathophysiological processes may not be easy in clinical practice, or the two processes may coexist in the same patient.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Neuropsychiatric disease (NPSLE)
What the sources say
- Not checked yetcites [2] Bertsias, 2010, EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task Force of the EULAR standing Committee for clinical Affairs, Ann Rheum Dis source
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“low-dose CYC (Euro-Lupus regimen, online supplementary table 5) is preferred over highdose CYC as it has comparable efficacy and lower risk of gonadotoxicity.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Renal disease
What the sources say
- Not checked yetcites 57 116 117
plaindirect- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These studies were performed almost exclusively in Asian populations and had short follow-up; hence, data have to be corroborated with longer duration studies in multiethnic populations.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Renal disease
plaindirect- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Each Task Force member rated their agreement with each statement.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > MeTHods
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“the SLR considered all English-language publi- cations from 01/2007 until 12/2017, with two exceptions: (1) treatment of skin disease, where an unrestricted date search was performed and (2) renal disease, where search was limited to the period 01/2012-12/2017”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > MeTHods
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
In the paper
“Patients with more severe proteinuria and longerstanding disease are less likely to respond or show more delayed responses.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Goals of treatment
What the sources say
- Not checked yetcites 22 23
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“RTX has demonstrated efficacy both in lupus and in patients with isolated immune thrombocytopaenia (ITP).”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Biological agents
What the sources say
- Not checked yetcites [74][75]5][76]
boosteddirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“it remains to be confirmed whether a lower dose will have comparable clinical effects.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Treatment of SLE Hydroxychloroquine
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
In the paper
“Major risk factors for retinopathy include duration of treatment (OR 4.71 for every 5 years of use), dose (OR 3.34 for every 100 mg daily dose), chronic kidney disease (adjusted OR 8.56) and pre-existing retinal or macular disease.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Treatment of SLE Hydroxychloroquine
What the sources say
- Not checked yetcites [37] Kim, 2017, Risk of retinal toxicity in longterm users of hydroxychloroquine, J Rheumatol source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Mycophenolate mofetil (MMF) is a potent immunosuppressant with efficacy in renal and non-renal lupus (although not in neuropsychiatric disease).”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Immunosuppressive (IS) drugs
What the sources say
- Not checked yetcites [51][52][53]
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Belimumab and RTX have also shown efficacy in mucocutaneous manifestations of SLE, although these studies have not included a validated activity score for skin lesions”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Skin disease
What the sources say
- Not checked yetcites 62 92-94
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Treatment of NPSLE depends on whether the underlying pathophysiological mechanism is presumed to be inflammatory or embolic/thrombotic/ischaemic.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Neuropsychiatric disease (NPSLE)
What the sources say
- Not checked yetcites 2 101
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
In the paper
“Flares are common in the disease course and contribute significantly to organ damage accrual and worse outcome.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Goals of treatment
What the sources say
- Not checked yetcites 17 25 26
plaindirect- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The EULAR standardised operating procedures 7 and the Appraisal of Guidelines Research and Evaluation instrument (AGREE II) 8 were followed.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > MeTHods
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Applying a Delphi-based methodology, 14 research questions were selected for SLR (online supplementary table 1).”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > MeTHods
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There are no studies examining retinal toxicity of quinacrine with the newer, more sensitive screening techniques (visual fields or optical coherence tomography); however with current knowledge, retinopathy is not considered a side-effect of quinacrine.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Skin disease
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“MMF or AZA may be used as maintenance therapy, with the former associated with fewer relapses”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Renal disease
What the sources say
- Not checked yetcites 121 122
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Patients with persistent disease may benefit from belimumab; more likely to respond are patients with high disease activity (eg, SLEDAI >10), prednisone dose >7.5 mg/day and serological activity (low C3/C4, high anti-dsDNA titres), with cutaneous, musculoskeletal and serological manifestations responding the most.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Biological agents
What the sources say
- Not checked yetcites [67][68][69]
hedgedconditional- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“After rounds of discussions, the committee reached a consensus of 33 final statements, grouped in four broad categories”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > MeTHods
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“it is not clear whether this should be applied to patients with lupus with any aPL antibodies or only to those carrying a high risk aPL profile”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Antiphospholipid antibodies (aPL) and antiphospholipid syndrome (APS)
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
In the paper
“SLE is an independent risk factor for cardiovascular disease (CVD), due to both traditional and disease-related risk factors, such as persistent disease activity, LN, presence of aPL and use of GC.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Cardiovascular disease
What the sources say
- Not checked yetcites [147][148][149]
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“recent studies support the value of a repeat kidney biopsy for the management of maintenance therapy, but more data are needed.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Cardiovascular disease
What the sources say
- Not checked yetcites 158 159
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No studies have been performed exclusively on patients with SLE-APS, with several studies excluding secondary APS due to lupus.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Antiphospholipid antibodies (aPL) and antiphospholipid syndrome (APS)
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Risk of infection in SLE is associated with both disease-related and treatment-related factors; high-dose GC therapy, CYC, MMF and RTX are all associated with an increased risk for infection, while high disease activity, severe leucopaenia and presence of renal involvement (±hypogammaglobulinaemia in nephrotic syndrome) also contribute independently.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Infections
What the sources say
- Not checked yetcites 48 140-143
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“The presence of aPL is associated with thrombotic and obstetric complications and increased risk of damage accrual.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Antiphospholipid antibodies (aPL) and antiphospholipid syndrome (APS)
What the sources say
- Not checked yetcites 133 134
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper relies on this without support.
The evidence from studies in patients with cutaneous lupus erythematosus applies to skin disease in SLE.
“A large body of evidence originates from studies in patients with cutaneous lupus erythematosus (CLE).”
The paper relies on this without support.
The bleeding hazard from aspirin observed in diabetics and elderly applies to patients with SLE.
“However, this has to be viewed in light of recent large studies in diabetics and elderly showing that the benefits of aspirin for primary CVD prevention are counterbalanced by the larger bleeding hazard.”
The paper relies on this without support.
The results of the rivaroxaban versus warfarin trial in APS with triple antiphospholipid positivity apply to patients with SLE-APS.
“A recent randomised, open-label trial comparing rivaroxaban to warfarin in APS with triple aPL positivity (~21% of patients had SLE-APS) was prematurely terminated due to an excess of thromboembolic events in the rivaroxaban arm.”
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“Due to the negative results of randomized, controlled trials (RCTs), RTX is currently only used off-label, in patients with severe renal or extrarenal (mainly hematological and neuropsychiatric) disease refractory to other IS agents and/or BLM, or in patients with contraindications to these drugs.73”
From Autoimmune diseases and immune-checkpoint inhibitors for cancer therapy: Review of the literature and personalized risk-based prevention strategy (2020) · cites this paper as [73]
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In the paper
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Abstract
“During chronic maintenance treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn.”
§ 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus > Glucocorticoids
“GC can provide rapid symptom relief, but the medium to longterm aim should be to minimise daily dose to ≤7.5 mg/day prednisone equivalent or to discontinue them”
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Self-citation
Metadata
- Authors
- Fanouriakis, A., Kostopoulou, M., Alunno, A., Aringer, M., Bajema, I., Boletis, J. N., Cervera, R., Doria, A., Gordon, C., Govoni, M., Houssiau, F., Jayne, D., Kouloumas, M., Kuhn, A., Larsen, J. L., Lerstrøm, K., Moroni, G., Mosca, M., Schneider, M., Smolen, J. S., Svenungsson, E., Tesar, V., Tincani, A., Troldborg, A., van Vollenhoven, R., Wenzel, J., Bertsias, G., & Boumpas, D. T.
- Affiliations
- University General Hospital Attikon (GR)
- General Hospital of Athens G. Genimatas (GR)
- University of Perugia (IT)
- University Hospital Carl Gustav Carus (DE)
- Leiden University Medical Center (NL)
- National and Kapodistrian University of Athens (GR)
- Hospital Clínic de Barcelona (ES)
- University of Padua (IT)
- University of Birmingham (GB)
- University of Ferrara (IT)
- Cliniques Universitaires Saint-Luc (BE)
- Addenbrooke's Hospital (GB)
- University Hospital Münster (DE)
- Rigshospitalet (DK)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- University of Pisa (IT)
- Heinrich Heine University Düsseldorf (DE)
- Medical University of Vienna (AT)
- Karolinska University Hospital (SE)
- Aarhus University Hospital (DK)
- University Hospital of Heraklion (GR)
- Corresponding author
- Fanouriakis, Antonis
- ORCID
- Fanouriakis, Antonis
- Kostopoulou, Myrto
- Alunno, Alessia
- Aringer, Martin
- Boletis, John N
- Cervera, Ricard
- Doria, Andrea
- Gordon, Caroline
- Govoni, Marcello
- Houssiau, Frédéric
- Jayne, David
- Kuhn, Annegret
- Moroni, Gabriella
- Mosca, Marta
- Schneider, Matthias
- Smolen, Josef S
- Svenungsson, Elisabet
- Troldborg, Anne
- Bertsias, George
- Boumpas, Dimitrios T
- Venue
- Annals of the Rheumatic Diseases
- Publisher
- Elsevier BV
- Published
- 2019-06
- Volume
- 78
- Issue
- 6
- Pages
- 736-745
- ISSN
- 0003-4967 (ISSN-L)
- OpenAlex
- W2927871970
- Semantic Scholar
- 2a633e82de004894ad42e33a1bbbd71645ad7dd5
- Cited by
- 2,011
- References
- 162
- Citations by year
- 2026: 132 · 2025: 189 · 2024: 322 · 2023: 349 · 2022: 347 · 2021: 317 · 2020: 271 · 2019: 77
- FWCI
- 191.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Annals of the Rheumatic Diseases (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, other-oa)
- Apollo (University of Cambridge) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- DIAL (Catholic University of Leuven) (submittedVersion, other-oa)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Padua Research Archive (University of Padova) (submittedVersion)
- Apollo
- Funders
- European League Against Rheumatism
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Rheumatology › Systemic Sclerosis and Related Diseases
- Health Sciences › Medicine › Rheumatology › Vasculitis and related conditions
- Keywords
- systemic lupus erythematosus, lupus management, hydroxychloroquine, glucocorticoid tapering, immunomodulators, belimumab, rituximab, disease flares, cutaneous lupus erythematosus, neuropsychiatric lupus, renal lupus, antiphospholipid antibodies, cardiovascular risk, infectious disease risk, EULAR recommendations
- MeSH terms
- Biological Products, Glucocorticoids, Humans, Hydroxychloroquine, Immunosuppressive Agents, Lupus Erythematosus, Systemic, Severity of Illness Index, Comorbidity, Evidence-Based Medicine, Disease Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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