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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\n      \u003Ch2\u003ESummary\u003C\/h2\u003E\n      \u003Cp id=\u0022p-1\u0022\u003EEach year at its annual meeting, the American College of Rheumatology (ACR) introduces new or updated evidenced-based clinical practice recommendations that reflect recent clinical trial results and\/or incorporate newly approved treatments. This article discusses updated recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs for rheumatoid arthritis, as well as new guidelines for the management of lupus nephritis.\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Erheumatology guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Erheumatoid arthritis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elupus\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n      \u003Cp id=\u0022p-2\u0022\u003EEach year at its annual meeting, the American College of Rheumatology (ACR) introduces new or updated evidenced-based clinical practice recommendations that reflect recent clinical trial results and\/or incorporate newly approved treatments. These recommendations advise clinicians of important new data that can improve the quality, appropriateness, and cost-effectiveness of patient care. At this year\u0027s meeting, Jasvinder Singh, MD, MBBS, University of Alabama, Birmingham, Alabama, USA, presented updated recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDS) for rheumatoid arthritis (RA). Bevra H. Hahn, MD, UCLA School of Medicine, Los Angeles, California, USA, presented new guidelines for the management of lupus nephritis.\u003C\/p\u003E\n      \u003Cp id=\u0022p-3\u0022\u003EBoth sets of recommendations were developed using the RAND\/UCLA Appropriateness Method, a formal group judgment method that contains elements of the Delphi technique and Nominal Group Process that uses clinically detailed \u2018scenarios\u2019 of diagnosis or treatment. Applying this method, the working group and core expert panel applied the results of a systematic review of the literature to create evidence reports and clinical scenarios, which were reviewed, rated, analyzed, and graded by members of the task force and eventually submitted to the ACR for finalization.\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n      \u003Ch2 class=\u0022\u0022\u003EUpdated Guidelines for Patients with Rheumatoid Arthritis\u003C\/h2\u003E\n      \u003Cp id=\u0022p-4\u0022\u003EAmong the important changes in the 2012 Updated Recommendations for the Treatment of RA are recommendations for the use of three newly approved drugs (tocilizumab, golimumab, and certolizumab), updated recommendations for switching therapies, indications for starting or resuming biologic or nonbiologic DMARDs, contraindications to the use of these agents, safety, and preventive immunizations. A key characteristic of these guidelines is that only \u201cpositive\u201d recommendations are included, meaning that there are no statements on when NOT to start a therapy, based on efficacy considerations, and no statements when it is \u201cpermissible\u201d to use an agent on the basis of safety considerations.\u003C\/p\u003E\n      \u003Cp id=\u0022p-5\u0022\u003EThe ACR 2012 Task Force panel recommends that in both early RA (defined as disease duration \u0026lt;6 months) and established RA (defined as disease duration \u22656 months or meeting 1987 ACR classification criteria), the target for disease activity should be either remission (Disease Activity Score [DAS] \u0026lt;1.6) or low disease activity (DAS \u0026lt;2.4).\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cdiv class=\u0022section subjects\u0022 id=\u0022sec-3\u0022\u003E\n      \u003Ch2 class=\u0022\u0022\u003EPatients with Established RA\u003C\/h2\u003E\n      \u003Cp id=\u0022p-6\u0022\u003E\n            \u003Cem\u003EIndications for DMARD Therapy and Switching Between DMARDs\u003C\/em\u003E\n         \u003C\/p\u003E\n      \u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \u003Cp id=\u0022p-7\u0022\u003EFor patients with low disease activity after 3 to 6 months of DMARD monotherapy (hydroxychloroquine, methotrexate (MTX), minocycline, or sulfasalazine), add MTX or leflunomide\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n            \u003Cp id=\u0022p-8\u0022\u003EFor patients with at least moderate disease activity (DAS \u0026gt;2.4 but \u2264 3.7) after 3 months of MTX\u003C\/p\u003E\n            \u003Cul class=\u0022list-simple \u0022 id=\u0022list-2\u0022\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n                  \u003Cp id=\u0022p-9\u0022\u003E\n                     \u003Cspan class=\u0022list-label\u0022\u003E\u2666 \u003C\/span\u003Eadd another non-methotrexate DMARD to MTX \u003Cstrong\u003EOR\u003C\/strong\u003E\n                     \u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n                  \u003Cp id=\u0022p-10\u0022\u003E\n                     \u003Cspan class=\u0022list-label\u0022\u003E\u2666 \u003C\/span\u003Eswitch to a different non-MTX DMARD\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\n      \u003Cp id=\u0022p-11\u0022\u003E\n            \u003Cem\u003EWhen to Add a Biologic to DMARDs\u003C\/em\u003E\n         \u003C\/p\u003E\n      \u003Cul class=\u0022list-unord \u0022 id=\u0022list-3\u0022\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n            \u003Cp id=\u0022p-12\u0022\u003EFor patients with low disease activity and poor prognosis (eg, functional limitation, extraarticular disease, rheumatoid factorpositivity, and\/or positive anti-CCP antibodies, and\/or bony erosions by radiography) after 3 to 6 months of MTX monotherapy or DMARD combination, add or switch to an anti-TNF biologic\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n            \u003Cp id=\u0022p-13\u0022\u003EFor patients with at least moderate disease activity after 3 months of MTX monotherapy or DMARD combination therapy, regardless of prognosis:\u003C\/p\u003E\n            \u003Cul class=\u0022list-simple \u0022 id=\u0022list-4\u0022\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n                  \u003Cp id=\u0022p-14\u0022\u003E\n                     \u003Cspan class=\u0022list-label\u0022\u003E\u2666 \u003C\/span\u003Eadd or switch to an anti-TNF biologic \u003Cstrong\u003EOR\u003C\/strong\u003E\n                     \u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-8\u0022\u003E\n                  \u003Cp id=\u0022p-15\u0022\u003E\n                     \u003Cspan class=\u0022list-label\u0022\u003E\u2666 \u003C\/span\u003Eadd or switch to abatacept or rituximab in anti-TNF-naive patients \u003Cstrong\u003EOR\u003C\/strong\u003E\n                     \u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-9\u0022\u003E\n                  \u003Cp id=\u0022p-16\u0022\u003E\n                     \u003Cspan class=\u0022list-label\u0022\u003E\u2666 \u003C\/span\u003Eadd or switch to another DMARD\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\n      \u003Cp id=\u0022p-17\u0022\u003E\n            \u003Cem\u003EWhen to Switch Between Biologics\u003C\/em\u003E\n         \u003C\/p\u003E\n      \u003Cul class=\u0022list-unord \u0022 id=\u0022list-5\u0022\u003E\u003Cli id=\u0022list-item-10\u0022\u003E\n            \u003Cp id=\u0022p-18\u0022\u003EPatients with at least moderate disease activity 3 months after failure of anti-TNF biologic should be switched to another anti-TNF biologic or a non-TNF biologic\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-11\u0022\u003E\n            \u003Cp id=\u0022p-19\u0022\u003EPatients with at least moderate disease activity 6 months after failing a non-TNF biologic (eg, abatacept, rituximab, or tocilizumab) should be switched to an anti-TNF biologic\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\n      \u003Cp id=\u0022p-20\u0022\u003E\n            \u003Cem\u003ESwitching Between Biologics as a Result of an Adverse Event (FDA definition)\u003C\/em\u003E\n         \u003C\/p\u003E\n      \u003Cul class=\u0022list-unord \u0022 id=\u0022list-6\u0022\u003E\u003Cli id=\u0022list-item-12\u0022\u003E\n            \u003Cp id=\u0022p-21\u0022\u003EPatients with at least moderate disease activity after failing an anti-TNF biologic because of a nonserious adverse event should be switched to another anti-TNF biologic or a non-TNF biologic\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-13\u0022\u003E\n            \u003Cp id=\u0022p-22\u0022\u003EPatients with at least moderate disease activity after failing a non-TNF biologic because of either a serious or nonserious adverse event should be switched to an anti-TNF biologic\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\n      \u003Cp id=\u0022p-23\u0022\u003E\n            \u003Cem\u003ERecommended Use of Biologics in RA Patients with Hepatitis is as Follows\u003C\/em\u003E:\u003C\/p\u003E\n      \u003Cul class=\u0022list-unord \u0022 id=\u0022list-7\u0022\u003E\u003Cli id=\u0022list-item-14\u0022\u003E\n            \u003Cp id=\u0022p-24\u0022\u003EAbatacept is recommended for patients with a past history of acute hepatitis B with positive hepatitis B core antibody\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-15\u0022\u003E\n            \u003Cp id=\u0022p-25\u0022\u003EEtanercept is recommended for patients with hepatitis C (whether treated or not)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-16\u0022\u003E\n            \u003Cp id=\u0022p-26\u0022\u003EThe use of biologics is not recommended for patients with untreated chronic hepatitis B or treated chronic hepatitis B with Child-Pugh Class B and higher\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\n      \u003Cp id=\u0022p-27\u0022\u003E\n            \u003Cem\u003EApproved Vaccinations\u003C\/em\u003E\n         \u003C\/p\u003E\n      \u003Cul class=\u0022list-unord \u0022 id=\u0022list-8\u0022\u003E\u003Cli id=\u0022list-item-17\u0022\u003E\n            \u003Cp id=\u0022p-28\u0022\u003EBefore starting a DMARD or a biologic, patients may receive:\u003C\/p\u003E\n            \u003Cul class=\u0022list-simple \u0022 id=\u0022list-9\u0022\u003E\u003Cli id=\u0022list-item-18\u0022\u003E\n                  \u003Cp id=\u0022p-29\u0022\u003E\n                     \u003Cspan class=\u0022list-label\u0022\u003E\u2666 \u003C\/span\u003Eall killed vaccines (pneumococcal, influenza, and hepatitis B)\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-19\u0022\u003E\n                  \u003Cp id=\u0022p-30\u0022\u003E\n                     \u003Cspan class=\u0022list-label\u0022\u003E\u2666 \u003C\/span\u003Erecombinant vaccines (human papilloma virus vaccine)\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-20\u0022\u003E\n                  \u003Cp id=\u0022p-31\u0022\u003E\n                     \u003Cspan class=\u0022list-label\u0022\u003E\u2666 \u003C\/span\u003Elive attenuated vaccines (herpes zoster)\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-21\u0022\u003E\n            \u003Cp id=\u0022p-32\u0022\u003EPatients already taking a DMARD or a biologic can receive any of the above vaccinations, EXCEPT herpes zoster, which is recommended only during DMARD therapy and is contraindicated in biologic users\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\n      \u003Cp id=\u0022p-33\u0022\u003E\n            \u003Cem\u003EOther\u003C\/em\u003E\n         \u003C\/p\u003E\n      \u003Cp id=\u0022p-34\u0022\u003EAnti-TNF biologics are contraindicated in RA patients with New York Heart Association class III or IV congestive heart failure and an ejection fraction \u226450%.\u003C\/p\u003E\n      \u003Cp id=\u0022p-35\u0022\u003EThe panel has also developed recommendations for the use of biologics in RA patients with previously treated malignancy (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n      \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\n         \u003Cdiv class=\u0022table-inline\u0022\u003E\n            \u003Cdiv class=\u0022callout\u0022\u003E\n               \u003Cspan\u003EView this table:\u003C\/span\u003E\n               \u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12633\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12633\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12633\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\n            \u003C\/div\u003E\n         \u003C\/div\u003E\n         \u003Cdiv class=\u0022table-caption\u0022\u003E\n            \u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-36\u0022 class=\u0022first-child\u0022\u003EThe Use of Biologics in RA Patients with Previously Treated Malignancy.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\n   \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n      \u003Ch2 class=\u0022\u0022\u003EUpdated Guidelines for Patients with Lupus Nephritis\u003C\/h2\u003E\n      \u003Cp id=\u0022p-37\u0022\u003EThe new Guidelines for the Management of Lupus Nephritis contain recommendations for screening, treatment, and patient management. Since treatment is dependent on biopsy results, the guidelines include treatment algorithms and recommendations for inducing improvements in various histological types of lupus nephritis, with a section on how to maintain improvements in patients who respond.\u003C\/p\u003E\n      \u003Cp id=\u0022p-38\u0022\u003EThe panel has assigned a Level of Evidence (LOE), based on the strength of the supporting data, to each recommendation. A: Evidence derived from multiple randomized controlled trials (RCTs) or a meta-analysis; B: Evidence based on a single RCT or nonrandomized study; C: Recommendation based on consensus, expert opinion, or case series.\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n      \u003Ch2 class=\u0022\u0022\u003ERenal Biopsy (All LOE: C)\u003C\/h2\u003E\n      \u003Cul class=\u0022list-unord \u0022 id=\u0022list-10\u0022\u003E\u003Cli id=\u0022list-item-22\u0022\u003E\n            \u003Cp id=\u0022p-39\u0022\u003EEvery patient with clinical evidence of active lupus nephritis, previously untreated, should undergo renal biopsy unless strongly contraindicated\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-23\u0022\u003E\n            \u003Cp id=\u0022p-40\u0022\u003EBiopsy results should be classified by the current International Society of Nephrology\/Renal Pathology Society classification [\u003Ca href=\u0022http:\/\/www.theisn.org\u0022\u003Ewww.theisn.org\u003C\/a\u003E]\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-24\u0022\u003E\n            \u003Cp id=\u0022p-41\u0022\u003EThe recommended therapeutic strategies are based on knowing the classification of nephritis on renal biopsy\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\n      \u003Cp id=\u0022p-42\u0022\u003EAll patients with lupus nephritis should receive the following adjunctive therapies:\u003C\/p\u003E\n      \u003Cul class=\u0022list-unord \u0022 id=\u0022list-11\u0022\u003E\u003Cli id=\u0022list-item-25\u0022\u003E\n            \u003Cp id=\u0022p-43\u0022\u003EHydroxychloroquine (LOE: C)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-26\u0022\u003E\n            \u003Cp id=\u0022p-44\u0022\u003EAngiotensin-converting enzyme inhibitor or angiotensin receptor blocker for proteinuria \u22650.5 g\/24 hrs or equivalent protein\/creatinine ratio (LOE: A)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-27\u0022\u003E\n            \u003Cp id=\u0022p-45\u0022\u003EMaintain blood pressure \u2264130\/80 mm Hg (LOE: A)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-28\u0022\u003E\n            \u003Cp id=\u0022p-46\u0022\u003EStatins for low-density lipoprotein cholesterol level (LDL) \u0026gt;100 mg\/dL (LOE: C)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-29\u0022\u003E\n            \u003Cp id=\u0022p-47\u0022\u003EPregnancy counseling for fertile women (LOE: C)\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\n      \u003Cp id=\u0022p-48\u0022\u003ETreatment algorithms have been developed for patients with ISN\/RPS Class III\/IV proliferative disease with and without crescents, which include recommendations for induction therapy, maintenance therapy for responders, and treatment approaches for nonresponders. For patients with Class V, purely membranous disease with nephrotic-range proteinuria (\u22653 g\/24 hours), the recommendation is to begin with mycophenolate mofetil (MMF) 2 to 3 g+prednisone 0.5 mg\/kg daily for 6 months. Patients who improve can be moved to a maintenance regimen of MMF 1 to 2 g\/day or azothioprine 2 mg\/kg\/day. Patients who do not improve should be treated with cyclophosphamide 500 to 1000 mg\/twice per month for 6 months + a steroid pulse that is followed by daily prednisone (0.5 to 1.0 mg\/kg\/day). New recommendations have also been issued for lupus nephritis in pregnancy.\u003C\/p\u003E\n      \u003Cp id=\u0022p-49\u0022\u003EMonthly monitoring is recommended for all patients with lupus nephritis (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E).\u003C\/p\u003E\n      \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\n         \u003Cdiv class=\u0022table-inline\u0022\u003E\n            \u003Cdiv class=\u0022callout\u0022\u003E\n               \u003Cspan\u003EView this table:\u003C\/span\u003E\n               \u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12634\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12634\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12634\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\n            \u003C\/div\u003E\n         \u003C\/div\u003E\n         \u003Cdiv class=\u0022table-caption\u0022\u003E\n            \u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-50\u0022 class=\u0022first-child\u0022\u003EMinimal Suggested Monthly Intervals for Monitoring of Lupus Nephritis.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\n      \u003Cp id=\u0022p-53\u0022\u003EDespite progress, a significant unmet need remains for patients with lupus nephritis. Approximately 20% to 35% of patients do not respond to treatment, and for many patients, response is slow (8 to 52 weeks). In addition, many responders can not completely discontinue therapies.\u003C\/p\u003E\n      \u003Cp id=\u0022p-54\u0022\u003EDr. Hahn noted that the recent approval of belimumab for adult patients with active, autoantibody-positive systemic lupus erythematosus (SLE) has led to a number of inquiries from SLE patients with lupus nephritis. She stressed that belimumab has not been studied in SLE patients with active nephritis. Although a post hoc analysis [Petri MA. \u003Cem\u003ELancet\u003C\/em\u003E 2011] of the published trial [Navarra SV et al. \u003Cem\u003ELancet\u003C\/em\u003E 2011] showed a significant (p\u0026lt;0.03) reduction in renal flares in the belimumab group, this was in patients with a history of nephritis, not currently active nephritis.\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/13\/8.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmw81\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmw81\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}