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Treat to Target in Systemic Lupus Erythematosus

Author

Aringer M1, Leuchten N2, Schneider M3. Rheum Dis Clin North Am. 2019 Nov;45(4):537-548. doi: 10.1016/j.rdc.2019.07.004. Epub 2019 Aug 22.

Author Information

1 Rheumatology, Medicine III, University Medical Center, Faculty of Medicine Carl Gustav Carus at the TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany. Electronic address: martin.aringer@uniklinikum-dresden.de.

2 Rheumatology, Medicine III, University Medical Center, Faculty of Medicine Carl Gustav Carus at the TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.

3 Department of Rheumatology, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.

Abstract

The treat-to-target principle of controlling inflammatory disease activity by means of disease-modifying antirheumatic drugs or immunosuppressive drugs also pertains to systemic lupus erythematosus (SLE). However, in SLE, intensifying immunosuppression with higher-dose glucocorticoids may worsen outcomes. Therefore, all current recommendations favor better disease control while limiting daily glucocorticoid doses to a maximum of 5 or 7.5 mg of prednisolone daily. Hydroxychloroquine and other prophylactic measures are added, and antiphospholipid syndrome is treated with anticoagulation and not with immunosuppression, which makes the approach of treat to target slightly more complex, mirroring the complexity of the disease.