Treatment of systemic lupus erythematosus and care of patients based on international recommendations

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by heterogeneous clinical manifestations, fluctuating disease activity, and the potential for irreversible organ damage. In recent years, the therapeutic approach to SLE has undergone a paradigm shift from symptom-based, glucocorticoid-centered management toward a treat-to-target strategy focused on achieving sustained remission or low disease activity while minimizing long-term treatment-related toxicity. This review summarizes current evidence and practical recommendations for the management and long-term care of SLE based on the 2019, and 2023 European Alliance of Associations for Rheumatology (EAAR/EULAR) recommendations and the 2025 American College of Rheumatology (ACR) guidelines. Contemporary management emphasizes regular assessment of disease activity and organ involvement, universal use of hydroxycloroquine unless contraindicated, and strict limitation of glucocorticoid exposure. Early introduction of immunosuppressive and biologic therapies, including targeted agents such as belimumab, anifrolumab, and voclosporin, has expanded therapeutic options for both non-renal SLE and lupus nephritis. Primary combination therapy is playing an increasingly important role in the severe forms of kidney disease. Current guidelines also highlight the importance of patient education, shared decision-making, non-pharmacological interventions, and proactive prevention of comorbidities, particularly cardiovascular disease, malignancies, infections, and osteoporosis. Modern SLE management is centered on individualized, target-driven, and multidisciplinary care. The integration of innovative therapies with preventive strategies and patient-centered approaches have the potential to improve long-term outcomes, quality of life, and survival in patients with SLE.