{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:04:55Z","timestamp":1790697895755,"version":"4.1.0"},"reference-count":52,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"unspecified","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Lupus Sci Med"],"accepted":{"date-parts":[[2026,6,13]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>(1) To explore practice patterns and variability in the management of systemic lupus erythematosus (SLE) in Spain, including the adoption of the treat-to-target (T2T) strategy; (2) to identify key multilevel contextual factors, barriers and facilitators; and (3) to propose strategies to overcome the identified barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative analysis was conducted using a contextual analysis (CA) framework based on the components of the Basel Approach for coNtextual ANAlysis. This involved collecting contextual data through a literature review and other relevant sources, as well as collecting primary data to address gaps via structured focus groups with rheumatologists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Considerable variability in SLE management was described by rheumatologists across regions and healthcare centres. Major barriers included disease complexity, delayed diagnosis, workforce shortages, limited training and awareness among healthcare professionals, insufficient multidisciplinary collaboration, underutilisation and lack of standardisation of clinical indices, inadequate patient education and poor integration of patient-reported outcomes into electronic medical records. Implementing T2T and clinical guidelines was rare due to perceived complexity, time constraints, a lack of digital support and limited training. Rheumatologists proposed several strategies, including improved training, structured referral pathways, digital solutions, shared decision-making tools, practical checklists and the development of multidisciplinary care networks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This CA highlights significant challenges in implementing evidence-based SLE management in Spain, particularly regarding the adoption of the T2T strategy. Addressing contextual factors at the healthcare provider, organisational and patient levels is crucial for improving the quality of care and patient outcomes. These findings lay the groundwork for designing tailored national-level implementation initiatives.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/lupus-2026-001979","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:30:13Z","timestamp":1787322613000},"page":"e001979","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Navigating the gap: the challenge of applying treat-to-target in routine lupus care\u2014a national perspective"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1811-2417","authenticated-orcid":false,"suffix":"MD, PhD","given":"Isabel","family":"Castrej\u00f3n","sequence":"first","affiliation":[{"name":"Servicio de Reumatolog\u00eda. Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n, Hospital General Universitario Gregorio Maranon, Madrid, Spain"},{"name":"Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7264-2577","authenticated-orcid":false,"given":"Mar\u00eda","family":"Galindo-Izquierdo","sequence":"additional","affiliation":[{"name":"Servicio de Reumatolog\u00eda, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"G\u00f3mez","sequence":"additional","affiliation":[{"name":"Servicio de Reumatolog\u00eda, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Manrique-Arija","sequence":"additional","affiliation":[{"name":"Hospital Regional Universitario de M\u00e1laga, M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Romero-Yuste","sequence":"additional","affiliation":[{"name":"Servicio de Reumatolog\u00eda, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paloma","family":"Vela","sequence":"additional","affiliation":[{"name":"Secci\u00f3n de Reumatolog\u00eda, Hospital General Universitario Dr Balmis, Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Est\u00edbaliz","family":"Loza","sequence":"additional","affiliation":[{"name":"Instituto de Salud Musculoesquel\u00e9tica SL, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Ot\u00f3n","sequence":"additional","affiliation":[{"name":"Instituto de Salud Musculoesquel\u00e9tica SL, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Marras","sequence":"additional","affiliation":[{"name":"Servicio de Reumatolog\u00eda, Hospital Cl\u00ednico Universitario Virgen de la Arrixaca, El Palmar, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"2026092908103179000_13.2.e001979.1","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.reuma.2020.01.006","article-title":"Contributions of the lupus register of the Spanish Society of Rheumatology (RELESSER) to the knowledge of systemic lupus erythematosus in Spain","volume":"17","author":"R\u00faa-Figueroa Fern\u00e1ndez de Larrinoa","year":"2021","journal-title":"Reumatol Clin (Engl Ed)"},{"key":"2026092908103179000_13.2.e001979.2","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1002\/acr.23015","article-title":"Comorbidities in Patients With Primary Sj\u00f6gren\u2019s Syndrome and Systemic Lupus Erythematosus: A Comparative Registries\u2010Based Study","volume":"69","author":"R\u00faa\u2010Figueroa","year":"2017","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026092908103179000_13.2.e001979.3","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000000267","article-title":"Comprehensive description of clinical characteristics of a large systemic lupus erythematosus cohort from the Spanish Rheumatology Society Lupus Registry (RELESSER) with emphasis on complete versus incomplete lupus differences","volume":"94","author":"R\u00faa-Figueroa","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"2026092908103179000_13.2.e001979.4","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10194306","article-title":"Long-Term Outcome in Systemic Lupus Erythematosus; 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