Lupus ITP Treatment — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeLupus ITP TreatmentSCE Rheumatology

A 50-year-old woman with SLE develops thrombocytopenia (platelets 35 x10^9/L) with no other cytopenias. Active SLE flare is confirmed with rising anti-dsDNA and falling complement. What is the first-line treatment for lupus-associated immune thrombocytopenia?

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Correct answer: A — Glucocorticoid treatment

Lupus-associated immune thrombocytopenia is treated with glucocorticoids as first-line (oral Prednisolone 1 mg/kg tapered over weeks to months or IV Methylprednisolone for acute severe thrombocytopenia). For refractory cases Rituximab has strong evidence (depletes anti-platelet antibody-producing B cells). IVIg provides rapid but temporary platelet increase and is useful for acute bleeding or pre-procedural preparation. Thrombopoietin receptor agonists (Eltrombopag Romiplostim) can be considered for chronic refractory ITP. Mycophenolate and Azathioprine serve as steroid-sparing maintenance agents. Splenectomy is reserved as a last resort.

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