2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus

Lisa R Sammaritano¹, Anca Askanase², Bonnie L Bermas³, Maria Dall'Era⁴, Alí Duarte-García⁵, Linda T Hiraki⁶, Mary Beth F Son⁷, Victoria P Werth⁸, Cynthia Aranow⁹, April Barnado¹⁰, Anna Broder¹¹, Hermine I Brunner¹², Benjamin F Chong³, Vaidehi R Chowdhary¹³, Aimee O Hersh¹⁴, Peter M Izmirly¹⁵, Marimee Jules¹⁶, Kenneth Kalunian¹⁷, Diane Kamen¹⁸, Tamar B Rubinstein¹⁹, Benjamin J Smith²⁰, Natalie M Smith²¹, Asha Thomas²², Homa Timlin²³, Daniel J Wallace²⁴, Muayad Azzam²⁵, Christie M Bartels²⁶, Joanne S Cunha²⁷, Kimberly DeQuattro²⁸, Andrea Fava²³, Gabriel Figueroa-Parra²⁹, Shivani Garg²⁶, Lais Lopes Almeida Gomes⁸, Maria C Cuéllar-Gutiérrez³⁰, Priyanka Iyer³¹, Andrew S Johannemann³², April Jorge³³, Shanthini Kasturi³⁴, Hassan Kawtharany²⁵, Jana Khawandi²⁵, Alexandra Legge³⁵, Kimberly P Liang²⁵, Megan M Lockwood³⁶, Alain Sanchez-Rodriguez³⁷, Marat Turgunbaev³⁸, Jessica N Williams³⁹, Amy S Turner³⁸, Reem A Mustafa²⁵

Affiliations

¹ Hospital for Special Surgery Weill Cornell Medicine, New York, New York.
² Columbia University, New York, New York.
³ University of Texas Southwestern Medical Center, Dallas.
⁴ University of California, San Francisco.
⁵ Mayo Clinic, Rochester, Minnesota.
⁶ The Hospital for Sick Children, Toronto, Ontario, Canada.
⁷ Boston Children's Hospital, Boston, Massachusetts.
⁸ University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia.
⁹ Feinstein Institutes for Medical Research, Manhasset, New York.
¹⁰ Vanderbilt University Medical Center, Nashville, Tennessee.
¹¹ Hackensack University Medical Center, Hackensack, New Jersey.
¹² Cincinnati Children's Hospital, University of Cincinnati, College of Medicine, Department of Pediatrics, Cincinnati, Ohio.
¹³ Yale University School of Medicine, New Haven, Connecticut.
¹⁴ The University of Utah, Salt Lake City.
¹⁵ NYU Grossman School of Medicine, New York, New York.
¹⁶ Salt Lake City, Utah.
¹⁷ University of California, San Diego.
¹⁸ Medical University of South Carolina, Charleston.
¹⁹ Albert Einstein College of Medicine, Bronx, New York.
²⁰ Florida State University, Tallahassee.
²¹ Hanover, Pennsylvania.
²² The Central Texas Veterans Health Care System (CTVHCS), Temple.
²³ Johns Hopkins University, Baltimore, Maryland.
²⁴ Cedars-Sinai, Los Angeles, California.
²⁵ University of Kansas, Kansas City.
²⁶ University of Wisconsin, Madison, Madison.
²⁷ Warren Alpert Medical School of Brown University, East Providence, Rhode, Island.
²⁸ University of Pennsylvania, Philadelphia.
²⁹ Mayo Clinic, Rochester, Minnesota, and University Hospital Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
³⁰ Mayo Clinic, Rochester, Minnesota, and Hospital del Salvador, Santiago, Chile.
³¹ University of California Irvine Medical Center, Orange.
³² Carolina Arthritis Center, Greenville, North Carolina.
³³ Massachusetts General Hospital, Boston.
³⁴ Tufts Medical Center, Boston, Massachusetts.
³⁵ Dalhousie University, Halifax, Nova Scotia, Canada.
³⁶ Georgetown University Hospital, Washington, DC.
³⁷ Mayo Clinic, Rochester, Minnesota, and Department of Internal Medicine, The American British Cowdray Medical Center, I.A.P, Mexico City, Mexico.
³⁸ American College of Rheumatology, Atlanta, Georgia.
³⁹ Washington University, St. Louis, Missouri.

PMID: 41182321
DOI: 10.1002/acr.25690

2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus

Lisa R Sammaritano et al. Arthritis Care Res (Hoboken). 2025.

. 2025 Nov 3.

doi: 10.1002/acr.25690. Online ahead of print.

Authors

Affiliations

¹ Hospital for Special Surgery Weill Cornell Medicine, New York, New York.
² Columbia University, New York, New York.
³ University of Texas Southwestern Medical Center, Dallas.
⁴ University of California, San Francisco.
⁵ Mayo Clinic, Rochester, Minnesota.
⁶ The Hospital for Sick Children, Toronto, Ontario, Canada.
⁷ Boston Children's Hospital, Boston, Massachusetts.
⁸ University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia.
⁹ Feinstein Institutes for Medical Research, Manhasset, New York.
¹⁰ Vanderbilt University Medical Center, Nashville, Tennessee.
¹¹ Hackensack University Medical Center, Hackensack, New Jersey.
¹² Cincinnati Children's Hospital, University of Cincinnati, College of Medicine, Department of Pediatrics, Cincinnati, Ohio.
¹³ Yale University School of Medicine, New Haven, Connecticut.
¹⁴ The University of Utah, Salt Lake City.
¹⁵ NYU Grossman School of Medicine, New York, New York.
¹⁶ Salt Lake City, Utah.
¹⁷ University of California, San Diego.
¹⁸ Medical University of South Carolina, Charleston.
¹⁹ Albert Einstein College of Medicine, Bronx, New York.
²⁰ Florida State University, Tallahassee.
²¹ Hanover, Pennsylvania.
²² The Central Texas Veterans Health Care System (CTVHCS), Temple.
²³ Johns Hopkins University, Baltimore, Maryland.
²⁴ Cedars-Sinai, Los Angeles, California.
²⁵ University of Kansas, Kansas City.
²⁶ University of Wisconsin, Madison, Madison.
²⁷ Warren Alpert Medical School of Brown University, East Providence, Rhode, Island.
²⁸ University of Pennsylvania, Philadelphia.
²⁹ Mayo Clinic, Rochester, Minnesota, and University Hospital Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
³⁰ Mayo Clinic, Rochester, Minnesota, and Hospital del Salvador, Santiago, Chile.
³¹ University of California Irvine Medical Center, Orange.
³² Carolina Arthritis Center, Greenville, North Carolina.
³³ Massachusetts General Hospital, Boston.
³⁴ Tufts Medical Center, Boston, Massachusetts.
³⁵ Dalhousie University, Halifax, Nova Scotia, Canada.
³⁶ Georgetown University Hospital, Washington, DC.
³⁷ Mayo Clinic, Rochester, Minnesota, and Department of Internal Medicine, The American British Cowdray Medical Center, I.A.P, Mexico City, Mexico.
³⁸ American College of Rheumatology, Atlanta, Georgia.
³⁹ Washington University, St. Louis, Missouri.

PMID: 41182321
DOI: 10.1002/acr.25690

Abstract

Objective: To provide evidence-based and expert guidance for the treatment and management of non-renal systemic lupus erythematosus (SLE); treatment and management of lupus nephritis are addressed in a separate guideline.

Methods: Clinical questions for treatment and management of SLE were developed in the PICO format (population, intervention, comparator, and outcome). Systematic literature reviews were developed for each PICO question, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess evidence quality and formulate recommendations. The Voting Panel achieved a consensus of ≥70% agreement on the direction (for or against) and strength (strong or conditional) of each recommendation.

Results: We present recommendations and ungraded, consensus-based good practice statements for the treatment and management of SLE that are applicable to pediatric and adult patients. Recommendations emphasize uniform treatment with hydroxychloroquine, limiting duration of glucocorticoid use, and early introduction of conventional and/or biologic immunosuppressive therapies to achieve and maintain control of SLE inflammation (remission or a low level of disease activity), reduce SLE-related morbidity and mortality, and minimize medication-related toxicities.

Conclusion: This guideline presents direction regarding treatment and management of SLE and provides a foundation for well-informed, shared clinician-patient decision-making. These recommendations should not be used to limit or deny access to therapies, as treatment decisions may vary due to the unique clinical situation and personal preferences of each person with SLE.

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References

REFERENCES

1. Izmirly PM, Parton H, Wang L, et al. Prevalence of systemic lupus erythematosus in the United States: estimates from a meta‐analysis of the Centers for Disease Control and Prevention national lupus registries. Arthritis Rheumatol 2021;73:991–996.
1. Dall'Era M, Cisternas MG, Snipes K, et al. The incidence and prevalence of systemic lupus erythematosus in San Francisco County, California: The California Lupus Surveillance Project. Arthritis Rheumatol 2017;69:1996–2005.
1. Drenkard C, Lim SS. Update on lupus epidemiology: advancing health disparities research through the study of minority populations. Curr Opin Rheumatol 2019;31:689–696.
1. Duarte‐García A, Hocaoglu M, Valenzuela‐Almada M, et al. Rising incidence and prevalence of systemic lupus erythematosus: a population‐based study over four decades. Ann Rheum Dis 2022;81:1260–1266.
1. Ferucci ED, Johnston JM, Gaddy JR, et al. Prevalence and incidence of systemic lupus erythematosus in a population‐based registry of American Indian and Alaska Native people, 2007‐2009. Arthritis Rheumatol 2014;66:2494–2502.

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2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus

Affiliations

2025 American College of Rheumatology (ACR) Guideline for the Treatment of Systemic Lupus Erythematosus

Authors

Affiliations

Abstract

References

REFERENCES

LinkOut - more resources

Full Text Sources