Non-pharmacological management for systemic lupus erythematosus and systemic sclerosis

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement. Systemic sclerosis (SSc) or scleroderma is another rheumatic autoimmune disease that affects blood vessels, skin, and visceral organs.

EULAR has previously published recommendations for the management of these two conditions focused on pharmacological drugs,1,2 but different non-pharmacological interventions may also be suitable for these patients to manage certain symptoms and complications. However, these kinds of supportive non-drug treatments have not yet been standardized, and in everyday practice they are often underused.

The new EULAR recommendations were developed by a multidisciplinary task force of patient research partners, nurses, and health care professionals from rheumatology as well as experts in physiotherapy, occupational therapy, psychology, diet, and podiatry. The work was completed in line with EULAR standardized operating procedures.

All information included in the final paper—published in the July 2023 issue of the Annals of the Rheumatic Diseases—was based on two systematic literature reviews—one on SLE, and one on SSc.

Overall, four overarching principles and 12 recommendations were developed. The principles acknowledge that non-pharmacological management of both conditions should be tailored to people's individual needs, expectations, and preferences and be based on a shared-decision making. This may require one or more intervention, and can be provided alone or as an adjunct to pharmaceutical treatment; however, non-pharmacological management should not substitute for pharmaceutical treatment when the latter is required.

The individual recommendations are then split into three groups, with those that apply to both diseases, followed by sets of specific considerations for each. The general aim is to improve people's health-related quality of life. This includes patient education and support for self-management, as well as advice around exercise and psychosocial interventions.

EULAR hopes these new recommendations will provide guidance on non-pharmacological interventions for people with SLE or SSc, and promote their use alongside pharmacotherapy to improve overall quality of care. However, they stress that non-pharmacological options should not replace drug therapy when it is required, and refer readers to the full management recommendations for SLE and SSc.1