Table 4.

GLADEL–PANLAR recommendations for neuropsychiatric and haematological manifestations

Treatment recommendations	Quality of the evidence	Strength of recommendation
Neuropsychiatric manifestations
In adult patients with lupus-related severe, acute neuropsychiatric manifestations
Use GCs plus CYC over GCs alone or GCs plus RTX.	Low	Weak
Haematological manifestations
In patients with severe acute lupus-related haemolytic anaemia (haemoglobin ≤8 g/dL)
Use high-dose GCs.	Low	Weak
If life-threatening or haemolytic anaemia remains active use RTX. Cost and availability may prompt the use of IS over RTX.	Low	Weak
In patients with severe lupus-related thrombocytopenia (platelet count ≤30 x10^9/L)
Use high-dose GCs.	Moderate	Weak
If first line failure, or life-threatening bleeding, urgent surgery or patients with current and ongoing infections: Use intravenous Ig with/without GCs or RTX plus GCs. Cost and availability may prompt the use of IS over RTX.	Moderate	Strong

CYC, cyclophosphamide; GC, glucocorticoid; GLADEL, Grupo Latino Americano de Estudio del Lupus; Ig, immunoglobulin; IS, immunosuppressant; PANLAR, Pan-American League of Associations of Rheumatology; RTX, rituximab.