2025 American College of Rheumatology guidelines for the treatment of SLE

Goals of systemic lupus erythematosus management are: 1) optimal disease control either by achieving and maintaining remission or a low level of disease activity; 2) decrease in morbidity and mortality; and 3) reduction of treatment-related toxicities. The American College of Rheumatology (ACR) recently published a 2025 ACR guideline summary for the treatment of systemic lupus erythematosus, to aid physicians in reaching these goals.¹

Their treatment recommendations are based on evidence-based data, clinical expertise, and patient-reported outcomes and preferences, with those highlighted as “strong” summarized here along with good practice statements for treatment.

Key learnings

Glucocorticoid exposure should be minimized (e.g. tapering prednisone from ≥5 mg/day to ≤5 mg/day within 6 months in patients with stable, controlled SLE), hydroxychloroquine used routinely unless contraindicated, and conventional or biologic immunosuppressive therapies introduced early.

Patients with SLE should be diagnosed and treated promptly, with the severity of disease activity guiding the intensity and choice of therapy; when multiple organ systems are involved, therapy should be directed toward all manifestations while prioritizing areas of irreversible damage.

Organ- or life-threatening SLE should be treated urgently with aggressive therapy such as high-dose glucocorticoid and immunosuppressive therapy; combination therapies should be considered, guided by the patient’s clinical condition and preference.

All treatment decisions should be individualized and involve shared decision-making between patients, rheumatologists, and relevant specialists.