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SLE Steroid Sparing — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeSLE Steroid SparingSCE Rheumatology

A 40-year-old woman with SLE has active disease with SLEDAI-2K of 12 and moderate skin and joint involvement. She is on Hydroxychloroquine and Prednisolone 15 mg daily. According to EULAR 2023 what treatment should be started to facilitate glucocorticoid reduction?

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Correct answer: C — Add an immunosuppressive drug (Methotrexate Azathioprine or Mycophenolate) and/or biologic (Belimumab or Anifrolumab)

EULAR 2023 recommends prompt initiation of immunosuppressive drugs and/or biologics to control disease and facilitate glucocorticoid tapering to ≤5 mg/day. For moderate non-renal SLE Methotrexate Azathioprine and Mycophenolate are options with Belimumab or Anifrolumab as biologic additions. Prior conventional immunosuppressive failure is NOT required before starting biologics. Cyclophosphamide is reserved for organ-threatening disease. Rituximab is for refractory cases. The emphasis is on early steroid-sparing therapy.

Reference: EULAR 2023 - Recommendations for management of SLE