GLADEL–PANLAR clinical practice guidelines for the management of systemic lupus erythematosus: 2025 update

The treatment of systemic lupus erythematosus has evolved rapidly over the past decade, particularly in lupus nephritis and in the musculoskeletal and cutaneous domains. These advances are especially relevant in Latin America, where patients face unique challenges related to health care access and resource availability. These evidence-based Latin American Group for the Study of Lupus–Pan-American League of Associations for Rheumatology guidelines provide an update of the 2018 recommendations, incorporating newly approved therapies and new evidence from randomized controlled trials into organ-based treatment algorithms that support earlier integration of biologic drugs when appropriate. The recommendations are complemented by overarching good-practice statements. The recommendations support individualized management according to organ involvement and disease severity, promoting earlier therapeutic optimization, including biologic drugs and targeted therapies when appropriate, the selective use of combination therapies and strategies to minimize glucocorticoid exposure. These updated guidelines reinforce a treat-to-target strategy in which remission or low disease activity are the primary therapeutic goals, and sustained remission represents the optimal long-term outcome. The recommendations also emphasize the need to implement evidence-based care within the realities of Latin American health care systems, where variability in access to treatment and health care resources might influence treatment. These Evidence-Based Guidelines update the 2018 Latin American Group for the Study of Lupus–Pan-American League of Associations for Rheumatology recommendations for the treatment of systemic lupus erythematosus in Latin America. The guidelines address regional challenges, while providing an organ-based framework that integrates evidence from randomized controlled trials and newly approved therapies.