November 2025

RHEUMATOLOGY

INTERNATIONAL EXPERT TASKFORCE REACHES CONSENSUS ON MANAGEMENT OF RARE SLE MANIFESTATIONS

Leading the effort
An international taskforce of 119 leading lupus experts has developed the first consensus-based treatment recommendations for 24 rare manifestations of systemic lupus erythematosus (SLE). This landmark review, published in The Lancet Rheumatology, was a collaborative effort by major SLE networks, including the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC).
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Rosalind Ramsey-Goldman, MD, DrPH, the John P. Gallagher Research Professor of Rheumatology at Northwestern Medicine and member and past SLICC Chair, contributed to this global initiative.

Why this matters
Existing guidelines focus on common organ involvement, leaving clinicians with limited guidance for rare but serious complications. This consensus fills that gap, offering severity-based strategies for manifestations often absent from clinical trials.

​What’s covered
The framework addresses rare complications across multiple organ systems:
  • Gastrointestinal: enteritis, pancreatitis
  • Pulmonary: pneumonitis, shrinking lung syndrome
  • Cardiac: myocarditis
  • Neurological: CNS vasculitis, seizures, psychosis
  • Cutaneous: lupus panniculitis, skin vasculitis

Key therapeutic principles
  • Foundational therapy: hydroxychloroquine and glucocorticoids
  • Severe cases: cyclophosphamide or mycophenolate mofetil
  • Refractory skin disease: targeted agents such as anifrolumab

This consensus provides clinicians with a practical framework for managing rare SLE complications, where evidence-based guidance has been lacking.
Rosalind Ramsey-Goldman, MD, DrPH, John P. Gallagher Research Professor of Rheumatology at Northwestern Medicine  

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