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SLE high disease activity — SCE Rheumatology MCQ

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HardConnective tissue diseasesSLE high disease activitySCE Rheumatology

A 29-year-old woman with autoantibody-positive SLE has active rash, synovitis and serological activity despite optimised standard therapy. Examination shows no severe active nephritis or neuropsychiatric lupus is present. Investigations show anti-dsDNA remains high and C3 is low. What is the most appropriate biologic?

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Correct answer: E — Belimumab

Belimumab is an evidence-based add-on biologic for active autoantibody-positive SLE with high disease activity despite standard care. TNF inhibitors such as adalimumab are not standard SLE biologics and can induce lupus-like disease. The best biologic depends on organ involvement, background therapy and commissioning criteria.

Reference: EULAR SLE recommendations; BSR lupus guideline; NICE TA752; BNF