Practical insights for the clinical implementation of the EULAR recommendations for patients with systemic lupus erythematosus

Sep 29, 2026

Objectives: EULAR recommendations for systemic lupus erythematosus (SLE) and lupus nephritis provide guidance for diagnosis, monitoring, and treatment, yet real-world implementation can be hindered by practical barriers such as limited practitioner time. Methods: Eight international SLE experts used an online survey of 17 open-ended questions to generate consensus advice on implementation, including early diagnosis, treatment targets, and medication choices for glucocorticoids, immunosuppressants, and biologics. Results: Advice addresses targets, actions, validated monitoring tools, and therapeutic optimization to prevent flares and glucocorticoid toxicities. Conclusions: Expert insights support routine adoption to help patients reach targets and prevent/delay organ damage progression.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Objectives

Methods

Results

Conclusions

Lupus ORIGINAL RESEARCH Practical insights for the clinical implementation of the EULAR recommendations for patients with systemic lupus erythematosus Ioannis Parodis ,1,2 Antonis Fanouriakis ,3 Alessandra Bortoluzzi 4 , Christof Iking-Konert,5 Julia Weinmann-Menke,6 Carmen San Román,7 Roger Abramino Levy,8 Inigo Rua-Figueroa,9 Tobias Alexander ,10,11 Zahir Amoura12,13 To cite: Parodis I, Fanouriakis A, Bortoluzzi A, et al. Practical insights for the clinical implementation of the EULAR recommendations for patients with systemic lupus erythematosus. RMD Open 2025;11:e006210 . doi:10 . 1136/ rmdopen-2025-006210 ► Additional supplemental material is published online only. To view, please visit the journal online ([https://doi.org/10.1136/](https://doi.org/10.1136/)[ ](https://doi.org/10.1136/)[rmdopen-2025-006210](rmdopen-2025-006210)) . Received 4 August 2025 Accepted 27 November 2025 © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group. For numbered affiliations see end of article. Correspondence to Dr Ioannis Parodis; [ioannis.parodis@ki.se](ioannis.parodis@ki.se) ABSTRACT Objectives The European Alliance of Associations for Rheumatology (EULAR) recommendations for the management of systemic lupus erythematosus (SLE) and lupus nephritis provide important guidance for practitioners on diagnosis, monitoring and treatment. However, practical barriers, such as time constraints, may pose challenges to practitioners when implementing these recommendations in real-world settings. We provide practical, expert-driven advice on how practitioners may effectively and efficiently implement the EULAR recommendations in routine clinical practice. Methods Eight international SLE experts convened and contributed opinions and advice for practitioners via an online survey containing 17 open-ended questions on implementation of the EULAR recommendations for early diagnosis, treatment targets and the use of glucocorticoids (GCs), immunosuppressants and biologics. Survey results were compiled and analysed to reach consensus on key advice points for each topic. Results Expert advice covered four key topics—setting standardised targets to help modify disease course and prevent organ damage; taking action to achieve these targets; monitoring of target achievement through validated clinical tools and frameworks; and optimising the therapeutic strategy to prevent flares and GC-associated toxicities. A total of 13 core expert-driven advice points were developed across these topics, including scenarios for consideration of earlier biological and/or conventional immunosuppressive use, specific risk factors for poorer prognosis to inform treatment decisions and suggestions on GC tapering. Conclusions These expert insights could facilitate implementation of the EULAR recommendations for the management of SLE in clinical practice, thereby helping patients achieve treatment targets and prevent and/or delay organ damage progression. PLAIN LANGUAGE SUMMARY The European Alliance of Associations for Rheumatology (EULAR) recommendations WHAT IS ALREADY KNOWN ON THIS TOPIC | ⇒ A European Alliance of Associations for Rheumatology (EULAR) taskforce published updated recommendations for the management of systemic lupus erythematosus (SLE) in late 2023.
⇒ EULAR announced their latest recommendations for lupus nephritis (LN) in 2025.
⇒ Practical barriers may pose challenges to practitioners in the implementation of these recommendations in real-world clinics.
WHAT THIS STUDY ADDS | | --- | | ⇒ We provide 13 key advice points, developed by a panel of eight international SLE experts, aimed to help practitioners implement the EULAR recommendations for the management of SLE.
⇒ The advice includes specific scenarios for the consideration of earlier use of targeted biologics and/ or conventional immunosuppressants, specific risk factors for poorer prognosis, strategies to help

FAQs

What is the main purpose of the expert advice in this study?

To provide practical, expert-driven guidance to help practitioners effectively and efficiently implement EULAR recommendations for managing systemic lupus erythematosus in routine clinical practice.

How were the advice points developed?

Eight international SLE experts contributed through an online survey with 17 open-ended questions, and the survey results were compiled and analysed to reach consensus on key advice points.

What four key topics are covered in the expert advice?

Setting standardized treatment targets, taking actions to achieve those targets, monitoring target achievement using validated tools/frameworks, and optimizing therapeutic strategy to prevent flares and glucocorticoid-associated toxicities.

Sep 29, 2026

Uploaded by Maya Linwood