title: Treatment Algorithms in Systemic Lupus Erythematosus.
abstract: OBJECTIVE
  To establish agreement on systemic lupus erythematosus (SLE) treatment.
  
  
  METHODS
  SLE experts (n = 69) were e-mailed scenarios and indicated preferred treatments. Algorithms were constructed and agreement determined (≥50% respondents indicating ≥70% agreement).
  
  
  RESULTS
  Initially, 54% (n = 37) responded suggesting treatment for scenarios; 13 experts rated agreement with scenarios. Fourteen of 16 scenarios had agreement as follows: discoid lupus: first-line therapy was topical agents and hydroxychloroquine and/or glucocorticoids then azathioprine and subsequently mycophenolate (mofetil); uncomplicated cutaneous vasculitis: initial treatment was glucocorticoids ± hydroxychloroquine ± methotrexate, followed by azathioprine or mycophenolate and then cyclophosphamide; arthritis: initial therapy was hydroxychloroquine and/or glucocorticoids, then methotrexate and subsequently rituximab; pericarditis: first-line therapy was nonsteroidal antiinflammatory drugs, then glucocorticoids with/without hydroxychloroquine, then azathioprine, mycophenolate, or methotrexate and finally belimumab or rituximab, and/or a pericardial window; interstitial lung disease/alveolitis: induction was glucocorticoids and mycophenolate or cyclophosphamide, then rituximab or intravenous gamma globulin (IVIG), and maintenance followed with azathioprine or mycophenolate; pulmonary hypertension: glucocorticoids and mycophenolate or cyclophosphamide and an endothelin receptor antagonist were initial therapies, subsequent treatments were phosphodiesterase-5 inhibitors and then prostanoids and rituximab; antiphospholipid antibody syndrome: standard anticoagulation with/without hydroxychloroquine, then a thrombin inhibitor for venous thrombosis, versus adding aspirin or platelet inhibition drugs for arterial events; mononeuritis multiplex and central nervous system vasculitis: first-line therapy was glucocorticoids and cyclophosphamide followed by maintenance with azathioprine or mycophenolate, and then rituximab, IVIG, or plasmapheresis; and serious lupus nephritis: first-line therapy was glucocorticoids and mycophenolate, then cyclophosphamide then rituximab.
  
  
  CONCLUSIONS
  We established variable agreement on treatment approaches. For some treatment decisions there was good agreement between experts even if no randomized controlled trial data were available.
authors.affiliation: Siriraj Hospital, Mahidol University, Bangkok, Thailand, and University of Western Ontario, London, Ontario, Canada.
authors.forename: Chayawee
authors.initials: C
authors.lastname: Muangchan
authors.affiliation: Karolinska Institute, Stockholm, Sweden.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: van Vollenhoven
authors.affiliation: Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Sasha R
authors.initials: SR
authors.lastname: Bernatsky
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: C Douglas
authors.initials: CD
authors.lastname: Smith
authors.affiliation: Jewish General Hospital and McGill University, Montreal, Quebec, Canada.
authors.forename: Marie
authors.initials: M
authors.lastname: Hudson
authors.affiliation: Istanbul University, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Inanç
authors.affiliation: University of Connecticut Health Center, Farmington.
authors.forename: Naomi F
authors.initials: NF
authors.lastname: Rothfield
authors.affiliation: University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Nash
authors.affiliation: North Shore LIJ Health System, Great Neck, New York.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Furie
authors.affiliation: Centre Hospitalier and School of Medicine of the University of Montreal, Montreal, Quebec, Canada.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Senécal
authors.affiliation: University of Toronto and University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Vinod
authors.initials: V
authors.lastname: Chandran
authors.affiliation: Hospital General de México and Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors.forename: Ruben
authors.initials: R
authors.lastname: Burgos-Vargas
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Ramsey-Goldman
authors.affiliation: University of Western Ontario, London, Ontario, Canada.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
mesh_terms: D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires