New guidelines released on lupus nephritis

The American College of Rheumatology released new guidelines last week on the screening, treatment and management of lupus nephritis, the first to specifically cover this topic.

According to the guidelines, 35% of adults in the U.S. with systemic lupus erythematosus have clinical signs of nephritis at diagnosis, and a total of 50% to 60% are estimated to develop nephritis in the first 10 years of the disease. African Americans and Hispanics are more likely to develop nephritis than whites, and men are more likely to develop it than women.

To provide expert advice for practicing clinicians managing patients with this condition, the American College of Rheumatology convened a task force panel to review previous guidelines, perform a systematic review of the evidence, grade the strength of the evidence, and create clinical scenarios, which were then discussed and voted on to arrive at the final recommendations.

The task force panel made recommendations in the following categories:

• renal biopsy and histology,
• adjunctive treatments,
• induction of improvement in patients with disease of increasing severity,
• maintenance of improvement in patients who respond to induction therapy,
• modification of therapies in patients who do not respond adequately to induction therapy,
• identification of vascular disease in patients with systemic lupus erythematosus and renal abnormalities,
• treatment of lupus nephritis in pregnant patients and
• monitoring activity of lupus nephritis.

The authors acknowledged that the guidelines are limited because panel members could not agree on definitions of some terms, including remission, flare and response, and also noted that no data are currently available to support specific recommendations on dosing steroids and tapering immunosuppressive drugs. They called for further research in these areas, as well as more studies on how new therapies for lupus can be used in patients with lupus nephritis.

The guidelines were published online May 3 by Arthritis Care & Research.