Refractory Cutaneous Lupus — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeRefractory Cutaneous LupusSCE Rheumatology

A 38-year-old woman with SLE has persistently active cutaneous disease (discoid lupus) despite Hydroxychloroquine and topical steroids. Mepacrine has been added without adequate response. What second-line systemic treatment should be considered?

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Correct answer: D — A steroid-sparing systemic agent

For cutaneous lupus refractory to antimalarials (Hydroxychloroquine plus Mepacrine) second-line systemic options include Methotrexate (evidence from RCTs for cutaneous lupus) Mycophenolate mofetil (effective for skin manifestations) and Dapsone (particularly for bullous lupus and discoid lupus). Anifrolumab (anti-IFNAR1) has strong evidence for skin-predominant SLE. Thalidomide is effective but limited by neuropathy risk and teratogenicity. EULAR 2023 SLE recommendations support early consideration of immunosuppressives and biologics for moderate-severe non-renal disease to facilitate glucocorticoid minimisation.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions