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SLE — SCE Rheumatology MCQ

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HardConnective tissue diseasesSLESCE Rheumatology

A patient with non-renal SLE has persistent inflammatory arthritis and cutaneous disease despite hydroxychloroquine, an optimised conventional immunosuppressant and repeated prednisolone courses. Infection is excluded. Which steroid-sparing escalation is appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Belimumab or anifrolumab with background therapy and glucocorticoid tapering

Explanation lettering: C = shown as A · A = shown as B · E = shown as C · B = shown as D · D = shown as E

E is correct. EULAR and current BSR strategy supports adding belimumab or anifrolumab for persistently active extrarenal SLE after standard therapy is optimised, particularly to facilitate glucocorticoid reduction. Choice depends on phenotype, previous therapies, comorbidity and commissioning. A normalises cumulative steroid harm. B removes foundational hydroxychloroquine. C assigns TNF inhibition a routine SLE role it does not have. D uses an organ-toxic induction drug indefinitely for non-organ-threatening disease. Biologic escalation still requires adherence review and confirmation that symptoms reflect active inflammation.

Reference: EULAR recommendations for management of systemic lupus erythematosus — 2023 update: https://ard.bmj.com/content/83/1/15