SLE- Guidelines and Treatment Considerations

Question 1

Treat to Target principles in SLE

Answer 1

Shared decisions between patient and MD
Prolong survival, minimize organ damage, improve health-related QoL
Understanding of SLE may require multidisciplinary management
Monitoring, follow-up, adjustments to therapy

Question 2

Treat to Target Recommendations in SLE

Answer 2

Remission or reduced disease activity
Flare prevention is a realistic goal
Not necessary to escalate treatment in asymptomatic patients with stable or increasing serological activity
Prevent damage accrual
Pay attention to HRQOL
Recognize and treat LN early
Optimize LN outcomes with 3 years of immunosuppressive therapy after induction
Lowest possible dose of steroid
Pay attention to APS
Give serious consideration to using antimalarials
Supportive treatments (for other disease states) should be used when necessary

Question 3

Non-pharm therapies for SLE

Answer 3

Sun protection
Vaccines
Exercise
No smoking
Weight loss
Get BP and lipids and glucose down

Question 4

In mild SLE, what are your first line options?

Answer 4

HCQ, GC PO/IM

Question 5

In mild SLE, what are your refractory options?

Answer 5

HCQ, GC PO/IM, MTX/AZA

Question 6

In moderate SLE, what are your first line options?

Answer 6

HCQ, GC PO/IV, MTX/AZA, CNI, MMF

Question 7

In moderate SLE, what are your refractory options?

Answer 7

HCQ, GO PO/IV, BEL, CNI, MMF

Question 8

In severe SLE, what are your first line options?

Answer 8

HCQ, GC PO/IV, MMF, CYC

Question 9

In severe SLE, what are your refractory options?

Answer 9

HCQ, GC PO/IV, CYC, RTX