{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:28:30Z","timestamp":1790728110261,"version":"4.1.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"GSK"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lupus"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To better understand the acceptance and potential application of the systemic lupus erythematosus (SLE) and lupus nephritis (LN) disease modification framework, which was first proposed in 2022, among experts in the Gulf region and Latin America.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Two cross-sectional Delphi surveys of a panel of expert SLE physicians were conducted, with a workshop discussion held between the two surveys. Surveys comprised multiple choice and open-response questions. Experts from Argentina, Bahrain, Brazil, Mexico, Oman, Saudi Arabia and United Arab Emirates were selected based on their demonstrated expertise in SLE. Consensus was indicated by &gt;75% agreement among experts in survey responses. Consensus was also evaluated by Gulf and Latin American regions to identify any regional differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was consensus across all the queried statements on the concept and components of disease modification, with some minor regional differences observed. Experts unanimously agreed that early diagnosis, early referral to a lupus specialist and a multidisciplinary approach are key factors for achieving disease modification and better patient outcomes. Aspects of the published SLE\/LN disease modification definition were either \u2018routinely\u2019 (31%) or \u2018sometimes\u2019 (62%) assessed in current clinical practice. A consensus was reached that biomarkers are a key component of evaluating disease modification (91%), but that currently available biomarkers are sub-optimal (96%). There was consensus that immunosuppressants (96%), biologics (92%) and hydroxychloroquine (88%) are disease modifying treatments. Experts from the Gulf, but not Latin America, agreed that glucocorticoids are not disease modifying.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There was strong consensus across experts from the Gulf and Latin America that the concept of disease modification can provide a valuable framework to support clinicians for the management of patients with SLE and LN. Experts emphasised that clear guidance is required for clinicians to apply the disease modification framework to their routine practice, and in varying local healthcare systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09612033251347341","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T05:03:34Z","timestamp":1749186214000},"page":"899-911","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Definition and application of systemic lupus erythematosus disease modification in emerging markets: Delphi panel consensus recommendations"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0647-929X","authenticated-orcid":false,"given":"Guillermo J","family":"Pons-Estel","sequence":"first","affiliation":[{"name":"Departamento de Medicina Interna, Grupo Oro\u00f1o-Centro Regional de Enfermedades Autoinmunes y Reum\u00e1ticas (GOCREAR), Rosario, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odirlei Andre","family":"Monticielo","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul,Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0657-4825","authenticated-orcid":false,"given":"Edgard","family":"Torres Dos Reis Neto","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Manuel","family":"Mejia-Vilet","sequence":"additional","affiliation":[{"name":"Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n, Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Al-Homood","sequence":"additional","affiliation":[{"name":"Department of Medical Specialties, Rheumatology Section, King Fahd Medical City Hospital (KFMC), Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6211-7448","authenticated-orcid":false,"given":"Reem","family":"Al-Jayyousi","sequence":"additional","affiliation":[{"name":"College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences and Mediclinic Middle Parkview Hospital, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana Parente Costa","family":"Seguro","sequence":"additional","affiliation":[{"name":"Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzan M","family":"Attar","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4773-9112","authenticated-orcid":false,"given":"Mercedes A","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Servicio de Reumatolog\u00eda, Hospital HIGA San Mart\u00edn, La Plata, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandra","family":"Babini","sequence":"additional","affiliation":[{"name":"Servicio de Reumatolog\u00eda, Hospital Italiano de C\u00f3rdoba, C\u00f3rdoba, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8176-287X","authenticated-orcid":false,"given":"Ibrahim A","family":"Almaghlouth","sequence":"additional","affiliation":[{"name":"College of Medicine Research Center, College of Medicine, King Saud University, Deraeya, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0542-8001","authenticated-orcid":false,"given":"Marina","family":"Scolnik","sequence":"additional","affiliation":[{"name":"Secci\u00f3n de Reumatolog\u00eda, Servicio de Cl\u00ednica M\u00e9dica, Hospital Italiano, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebasti\u00e1n Juan","family":"Magri","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Hospital Italiano, La Plata, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily Figueiredo Neves","family":"Yuki","sequence":"additional","affiliation":[{"name":"Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Teixeira","family":"Montezuma Sales","sequence":"additional","affiliation":[{"name":"Department of Medicine (Nephrology), Universidade Federal de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Medrano-Ramirez","sequence":"additional","affiliation":[{"name":"Departamento de Reumatolog\u00eda, Hospital General de M\u00e9xico, Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1524-8220","authenticated-orcid":false,"given":"Alhussain","family":"Asiri","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rheumatology Unit, Asir Central Hospital, Al Rabwah, Abha, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humeira","family":"Badsha","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, HBG Medical Center, Dubai Healthcare City, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0282-4444","authenticated-orcid":false,"given":"Faisal","family":"Elbadawi","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Dubai Hospital, Deira, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humaid A","family":"Al Wahshi","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeyad","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Ar Rimayah, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saadeya","family":"Abdulkarim","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Salmaniya Hospital, Manama, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razia","family":"Hussain","sequence":"additional","affiliation":[{"name":"Immunology, GSK, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Rocha","sequence":"additional","affiliation":[{"name":"Immunology, GSK, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raef","family":"Gouhar","sequence":"additional","affiliation":[{"name":"Immunology, GSK, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8927-6024","authenticated-orcid":false,"given":"Munther","family":"Khamashta","sequence":"additional","affiliation":[{"name":"Immunology, GSK, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,6]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.22672"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clicom.2023.10.002"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/09612033221137248"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keac695"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep346"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2023-224762"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2023.09.002"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rdc.2005.09.005"},{"key":"e_1_3_7_10_2","unstructured":"Agency EM. Guideline on medicinal products for the treatment of alzheimer's disease and other dementias. https:\/\/www.ema.europa.eu\/en\/documents\/scientificguideline\/guideline-medicinal-products-treatment-alzheimers-disease-other-dementiasrevision-1_en.pdf Accessed February 2024."},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2021-000634"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-213512"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2023-001124"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-eular.7861"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223035"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-015-0702-6"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.md.0000104742.42401.e2"},{"key":"e_1_3_7_18_2","first-page":"1934","article-title":"The systemic lupus activity measure-revised, the Mexican systemic lupus erythematosus disease activity index (SLEDAI), and a modified SLEDAI-2K are adequate instruments to measure disaease activity in systemic lupus erythematosus","volume":"10","author":"Uribe AG","year":"2004","unstructured":"Uribe AG, Vil\u00e1 LM, McGwin GJr, et al. The systemic lupus activity measure-revised, the Mexican systemic lupus erythematosus disease activity index (SLEDAI), and a modified SLEDAI-2K are adequate instruments to measure disaease activity in systemic lupus erythematosus. J Rheumatol 2004; 10: 1934\u20131940.","journal-title":"J Rheumatol"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11195759"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.42023"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2024.09.007"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/0961203320988586"},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22762"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00296-5"},{"key":"e_1_3_7_25_2","doi-asserted-by":"publisher","DOI":"10.1191\/096120300678828046"},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2018-000279"},{"key":"e_1_3_7_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/0961203318817826"},{"key":"e_1_3_7_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.24649"},{"key":"e_1_3_7_29_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-216303"},{"key":"e_1_3_7_30_2","doi-asserted-by":"publisher","DOI":"10.1177\/09612033211030008"},{"key":"e_1_3_7_31_2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.14.151290"},{"key":"e_1_3_7_32_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-022-02673-2"},{"key":"e_1_3_7_33_2","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.172569"},{"key":"e_1_3_7_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2019.07.018"},{"key":"e_1_3_7_35_2","unstructured":"FDA. Mycophenolate mofetil product information. Available from: chrome-extension:\/\/efaidnbmnnnibpcajpcglclefindmkaj\/. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2009\/050722s021 050723s019 050758s019 050759s024lbl.pdf Accessed March 2024."},{"key":"e_1_3_7_36_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0141-9"}],"container-title":["Lupus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09612033251347341","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09612033251347341","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09612033251347341","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:29:03Z","timestamp":1777678143000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09612033251347341"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,6]]},"references-count":35,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1177\/09612033251347341"],"URL":"https:\/\/doi.org\/10.1177\/09612033251347341","relation":{},"ISSN":["0961-2033","1477-0962"],"issn-type":[{"value":"0961-2033","type":"print"},{"value":"1477-0962","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,6]]}}}