Therapeutics of SLE

Question 1

Goals of treatment

Answer 1

Ensure long-term survival
Induction and maintenance of remission
Maintain or improve quality of life (get back to work)
Minimize complications

Question 2

Non-drug therapy

Answer 2

Balanced routine of rest and exercise
Avoidance of overexertion and stress
Smoking cessation
Limited sun

Question 3

Why smoking cessation?

Answer 3

Nicotine decreases the effects of antimalarials

Question 4

NSAIDs use when?

Answer 4

Fever
Arthritis
Skin Rash
Serositis

Question 5

NSAIDs clinical pearls

Answer 5

Always use an anti-inflammatory doses
Decrease in renal function
May need a gastro-protective agent (PPI)

Question 6

Antimalarial agents?

Answer 6

Chloroquine

Hydroxychloroquine

Question 7

When and why use antimalarials?

Answer 7

ALL patients (increases survival)
Control disease exacerbation

Question 8

Special property of antimalarials?

Answer 8

Steroid sparing

Question 9

Dosing and action?

Answer 9

H: 200-400 mg/day

Onset of action is prolong so need a corticosteroid bridge therapy

Question 10

Antimalarial KEY POINT

Test question

Answer 10

Eye exams!!

Question 11

Corticosteroids when do use?

Answer 11

Prednisone
For more serious clinical manifestations
Unresponsive to other meds

Question 12

Corticosteroids dosing

Answer 12

Mild: 10-20 mg/d
Severe: 1-2 mg/kg
Taper to lowest effective dose

Question 13

Corticosteroid pulse therapy

Answer 13

Large IV of methylprednisolone 500-1000 mg x 3-6d
Then oral 1-1.5 mg/kg/d prednisone
Taper down

Question 14

Corticosteroids clinical pearls

Answer 14

Need osteoporosis prophylaxi

Question 15

Immunosuppresive agents

Answer 15

Cyclophosphamide

Azathioprine

Question 16

When do you use immunosuppresive agents?

Answer 16

Typically in combo with corticosteroids

Question 17

Cyclophosphamide Dosing

Answer 17

Qmonth x 6 months, then Q3 months x 2 years

WBC >1500 (increase dose if it begins to fall

Question 18

Cyclophosphamide AE

Answer 18

Prego X
Bladder toxicity (well hydrate pts)

Question 19

Azathioprine

Answer 19

Steroid Sparing
Long-term maintenance
Less toxic

Question 20

Azathioprine Dose

Answer 20

2 mg/kg/d

Question 21

Immunosuppresive agent clinical pearls

Answer 21

Cyclophosphamide: induction of remission
Azathioprine: maintenance of remission

Question 22

Biologic agents

Answer 22

Belimumab

Retuximab

Question 23

When do you use biologics?

Answer 23

In combo with others for induction of remission

Question 24

Biologics dosing

Answer 24

B: 10 mg/k q2wks x 3, then 10 mg kg q4wks
R: 375/mg q wk (wk 1-3 of 4 wk cycle OR 500-1000 mg on days 1 and 15

Question 25

Biologics pearls

Answer 25

AA should not be placed on belimumab

Never combine two biologics

Question 26

Monitoring

Answer 26

Renal function assessment

SCr

Question 27

Drug Induced Lupus caused by

Answer 27

Procainamide

Hydralazine

Question 28

Drug Induced Lupus

Answer 28

Older pts
No gender
Musculoskeletal symptoms
Treat with NSAIDs and discontinue causative agent

Question 29

SLE

Answer 29

15-45
Females
Psychiatric and renal
Malar rash (butterfly rash)