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SLE high disease activity — SCE Rheumatology MCQ

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ModerateConnective tissue diseasesSLE high disease activitySCE Rheumatology

A 34-year-old woman has active autoantibody-positive SLE despite hydroxychloroquine, mycophenolate and low-dose prednisolone. Examination shows arthritis, rash and serological activity persist. Investigations show anti-dsDNA is high, C3 is low and there is no severe renal or CNS disease. What is the most appropriate management?

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Correct answer: C — Add belimumab

Belimumab is an add-on option for active autoantibody-positive SLE with high disease activity despite standard therapy when severe active renal or CNS disease is not the dominant issue. Etanercept is not a standard SLE biologic and may worsen lupus-like disease. Biologic escalation in SLE should sit alongside optimised antimalarial use, steroid minimisation and organ-specific assessment.

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