Data from: First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)–Pan-American League of Associations of Rheumatology (PANLAR)

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an ‘overarching’ treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.

系统性红斑狼疮（Systemic lupus erythematosus, SLE）是一种复杂且具有高度异质性的自身免疫性疾病，其诊断与治疗均是临床面临的重大难题。拉丁美洲地区的SLE患者存在特有的临床问题，在制定该病治疗指南时需予以充分考量。本研究旨在为拉丁美洲的狼疮患者制定临床实践指南。两个独立工作组（分别为具备狼疮诊疗经验的风湿科医师与临床方法学家）于2016年4月在巴拿马巴拿马城召开首次会议，针对拉丁美洲SLE患者最常见的临床问题拟定了一系列待解答议题，并基于当前可获得的最佳证据对上述议题进行分析，同时依照推荐分级、评估、制定与评价（Grading of Recommendations Assessment, Development and Evaluation, GRADE）方法以标准化格式进行总结。所有初步研究结果于2016年11月在华盛顿特区召开的第二次线下会议中得到充分讨论。最终形成包含九大器官/系统板块的核心研究结果，并新增了"统领性"诊疗策略章节，研究特别着重关注了指南在本地区的落地实施问题。针对肌肉骨骼、黏膜皮肤、肾脏、心脏、肺部、神经精神、血液系统受累及抗磷脂综合征等情况，研究对最优药物治疗方案进行了梳理评估；各章节均对主要治疗手段的应用价值进行了总结，包括糖皮质激素、抗疟药、免疫抑制剂、治疗性血浆置换、贝利尤单抗、利妥昔单抗、阿巴西普、低剂量阿司匹林及抗凝剂等。所有推荐意见均综合考量了治疗获益与风险、证据确定性、患者价值观与偏好、方案可行性、可及性及公平性等维度，并特别聚焦于种族与社会经济层面的差异。本研究已成功制定针对拉丁美洲狼疮患者的临床实践指南，可在类似医疗环境中推广应用。