What are the current NICE guidelines for the management of mild to moderate SLE in primary care?

Current NICE guidelines do not provide a specific, standalone guideline for the management of mild to moderate systemic lupus erythematosus (SLE) in primary care. However, general principles for autoimmune and inflammatory rheumatological conditions can be applied.

In primary care, the focus should be on early recognition and referral to specialist rheumatology services for diagnosis and management, especially if systemic symptoms or organ involvement are suspected. Prompt referral is essential for suspected persistent synovitis or systemic autoimmune disease manifestations to ensure specialist assessment and initiation of appropriate disease-modifying treatment ².

While specific SLE pharmacological management is typically initiated and monitored in secondary care, primary care plays a key role in ongoing monitoring, supporting medication adherence, managing comorbidities, and providing patient education about disease and flare recognition ¹,⁵.

Glucocorticoids may be used as bridging therapy under specialist guidance, but their use in primary care should be cautious due to potential adverse effects ¹.

Primary care should also monitor for complications and adverse effects of immunosuppressive therapies, including blood pressure, renal function, and signs of infection, and liaise closely with specialists for any concerns ⁵.

Patient involvement in decision-making and shared care models with clear communication between primary and secondary care are recommended to optimize long-term management ²,⁶.