Systemic lupus erythematosus

Questions discussed in this category

How would you approach the treatment of an SLE patient with refractory mucocutaneous ulcerations and lichenoid skin eruption despite treatment with MMF, Aza, Benlysta, Saphnelo, Rituximab, and JAK inhibitors?

The patient was diagnosed on the basis of ANA 1:1,280, strongly positive Smith, Sm-RNP, dsDNA, pericarditis, inflammatory arthritis, and discoid lupus...

5 Answers available

What is the clinical significance of a low titer RNP, negative Sm, but Sm/RNP that is very high titer?

I'm uncertain why both individual parts can be so low/negative but together very positive. Is there an assay discrepancy, a false positive?

1 Answer available

How would you approach management of a patient with longstanding history of SLE, but having active psoriasis?

SLE manifestations include arthralgias and cytopenias which are stable. Previously did well on methotrexate, but developed GI side effects. HCQ is on ...

3 Answers available

Would you accept the diagnosis of SLE on the basis of an AVISE CTD panel where the results just showed a positive EC4d or BC4d, positive ANA>1/80 + one clinical criteria such as multiple tender joints but did otherwise not fulfill criteria for SLE?

2 Answers available

How would you manage a patient with CKD4 due to lupus nephritis of unknown class who develops AKI requiring hemodialysis and nephrotic range proteinuria and is found to have atrophic kidneys on imaging?

3 Answers available

Do you generally prefer to continue hydroxychloroquine in lupus patients who develop ESRD despite the low likelihood of clinically active disease in this patient population?

4 Answers available

How do you counsel patients who experience diarrhea from mycophenolate mofetil (Cellcept)?

Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies?

2 Answers available

What is your workup and treatment approach for cranial neuropathies in patients with lupus?

1 Answer available

For patients with SLE, is there an ANC level for which you would hold or adjust hydroxychloroquine in an asymptomatic patient?

UpToDate recommends Hydroxychloroquine for all SLE patients, but neutropenia is sometimes ascribed to HCQ rather than the underlying disease. What lev...

2 Answers available

What is your approach when surgeons want to stop hydroxychloroquine prior to surgery?

The index question is: "neurosurgeons lately want to stop hydroxychloroquine prior to spinal surgery. Anyone allowing this for lupus patients and for ...

3 Answers available

Should HCQ be continued in an asymptomatic SLE patient who has received renal transplant?

If a patient has received a kidney transplant for SLE-LN and is stable and doing well. Managed by their transplant team and on chronic immunosuppressi...

2 Answers available

How would you approach potentially tapering maintenance mycophenolate mofetil in a patient with a history of class IV LN that has been in remission for >5 years?

The case prompting the question is a female in her late teens who was diagnosed with Class IV LN at her prepubescent age and was treated with HCQ and ...

1 Answer available

What is your approach for severe SCLE in patients unable to tolerate HCQ?

3 Answers available

Do you recommend avoidance of vaginal estrogen in patients with SLE?

What factors do you discuss when counseling the patient?

2 Answers available

How would you approach management of a young male patient with discoid lupus who has had minimal response to hydroxychloroquine (and subtherapeutic whole blood levels) who continues to use tobacco products?

2 Answers available

Would you continue belimumab in high risk lupus patients with overlapping scleroderma features with ILD who become pregnant and who are already on HCQ and azathioprine?

1 Answer available

Would you use voclosporin or belimumab as adjunctive therapy for treatment of lupus nephritis?

How does the presence of extra-renal manifestations influence this decision?

8 Answers available

How do you approach management of patients with lupus and transverse myelitis not responding to pulse dose steroids?

3 Answers available

Would you consider belimumab for an SLE patient who has generalized hair thinning, leukopenia (WBC <3), low C3, and markedly positive anti-dsDNA who is otherwise asymptomatic?

The patient is already on hydroxychloroquine.

1 Answer available

What is your approach to the diagnosis and management of optic chiasmitis in systemic lupus erythematosus?

And have you ever seen it occur in isolation without any other manifestations of SLE?

1 Answer available

What is your threshold to repeat a kidney biopsy in a patient with a history of lupus nephritis who is on maintenance therapy and develops subtle changes in urinary protein excretion or microscopic hematuria?

3 Answers available

Would you switch azathioprine to a different immunosuppressant if a controlled patient with SLE develops melanoma and/or non-melanoma skin cancer?

2 Answers available

Do you hospitalize patients with newly diagnosed lupus nephritis and nephrotic syndrome if you are able to provide pulse steroids outpatient and follow them closely?

When do you decide to hospitalize?

1 Answer available

Do you require lupus patients with ESKD or advanced CKD to be on minimal immunosuppression around the time of kidney transplantation?

1 Answer available

What is your preferred add-on for membranous lupus nephritis (2.2 grams of protein, normal creatinine) in a young woman who is currently on hydroxychloroquine and mycophenolate 1500 mg 2x daily?

2 Answers available

How would you approach the management of a new SLE patient presenting with lupus podocytopathy with FSGS and severe proteinuria (Pr/Cr 18) without immune complex deposition?

2 Answers available

How often should lupus anticoagulant be checked in patients with SLE if prior was negative or if prior was positive?

1 Answer available

How would you approach a young patient with bilateral lower extremity muscle weakness and positive anti-Smith, dsDNA, RNP, Raynaud’s, and pericardial effusion but normal muscle enzymes?

MRI with muscle edema but biopsy pending. Would you consider this overlap myositis even though muscle enzymes are normal?

2 Answers available

How do you approach interpreting a low titer dsDNA (such as crithidia 1:40 to 1:80) in the setting of a moderately elevated ANA without other specific features of SLE?

For example, the patient may have other findings such as an elevated CRP. Would you diagnose SLE, or would you want to see other serologies or finding...

2 Answers available

How do you gain access to quinacrine, and what has your recent experience been?

How long has it been back on the market? What is the typical cost for patients? Are certain compounding pharmacies regularly carrying it?

4 Answers available

How would you approach the work up of SLE in a patient over 80 years old?

How would you work up an elderly female with persistent anemia secondary to warm AIHA requiring almost monthly transfusion, with positive ANA,dsDNA (b...

3 Answers available

What is your approach to nephrology referral for patients with lupus nephritis?

Do you refer all patients with suspected LN, patients with confirmed LN, or patients with specific features (not responding to usual therapy, certain ...

3 Answers available

What is your approach to practical monitoring of lupus disease activity in clinical practice?

What disease activity index do you find more useful and most practical in a busy clinical setting? How often do you assess it?This question is part of...

1 Answer available

What is your approach to dosing and duration of rituximab for refractory lupus nephritis not responsive to cyclophosphamide or mycophenolate?

Do you add low-dose mycophenolate to use in combination with Rituximab in these patients?

1 Answer available

Do you feel comfortable combining mycophenolate mofetil with azathioprine in patients with lupus?

3 Answers available

Do you choose rituximab or calcineurin inhibitors for patients with class IV/V lupus nephritis who are refractory to standard of care therapies?

1 Answer available

What is your approach to transitioning an SLE patient from a pregnancy incompatible regimen to pregnancy compatible regimen?

For example, when switching from MMF to azathioprine, do you overlap the treatments as you lower the dose of one and add the other?

3 Answers available

How would you manage a case of subcutaneous panniculitis-like T cell lymphoma (A/B) who is already on steroids and methotrexate for autoimmune disease?

1 Answer available

Would you use belimumab in a breastfeeding patient with SLE who has persistent joint pain, leukopenia and elevated dsDNA despite HCQ and azathioprine?

3 Answers available

What is your approach to diagnosis and evaluation of nonbacterial thrombotic endocarditis (Libman-Sacks)?

Patient with negative blood cultures, completed 6 weeks of IV antibiotics and vegetation persists. CT imaging without evidence of malignancy. No evide...

3 Answers available

Any concern for lupus flare in patients undergoing laser hair removal?

2 Answers available

Would you treat a patient aggressively for lupus nephritis if they have persistent proteinuria over 1 gram but cannot get a timely kidney biopsy?

3 Answers available

How would you manage a patient with SLE that has a remote history of positive anti-phospholipid antibodies with a current DVT and now completely negative APLs?

Would you still plan for lifelong anticoagulation in this scenario?

1 Answer available

Would you increase the hydroxychloroquine dose to more than 5 mg/kg/day in a compliant patient with active non-organ threatening lupus (skin+joints) if serum hydroxychloroquine is not at goal until you reach an acceptable concentration?

3 Answers available

What is your approach to patients with SLE who develop a rash after hydroxychloroquine initiation?

3 Answers available

How do you approach follow up of young patients with isolated +ANA, but no current clinical signs or symptoms of SLE?

This question is part of a collaboration with RheumMadness and is specifically in reference to: Antibodies Before SLE.

6 Answers available

Would you consider the use of rilonacept to treat refractory pericarditis in lupus?

5 Answers available

Do you use anti-DFS70 Ab to help reduce the posttest probability of ANA-positive patients having a systemic autoimmune disease if other autoantibodies are negative?

ANA patients referred to rule out CTD is a work-intensive, costly referral type. If they are positive for Anti-Dense Fine Speckled Protein 70 kDa (DFS...

1 Answer available

How do you approach a negative ANA and positive dsDNA in patients with arthralgia, hair loss, or other UCTD features?

5 Answers available

Would you add voclosporin to mycophenolate for refractory proteinuria in a patient with low EF?

Low EF in the range of 30%

1 Answer available

What would be the clinical role of SGLT-2 inhibitors for lupus nephritis given it has an indication for proteinuria related to CKD?

5 Answers available

Is there a role for voclosporin in non-renal lupus?

1 Answer available

When would you consider a kidney biopsy in a patient with longstanding diabetes and hypertension (baseline creatinine 4-5, 4+ proteinuria) who was recently found to have dsDNA positivity?

1 Answer available

How do you manage patients with SLE undergoing assisted reproductive therapy with estrogenic effects?

2 Answers available

At what point would you consider anticoagulation in a pregnant patient with lupus nephritis and non-nephrotic range proteinuria?

3 Answers available

Do you continue belimumab throughout pregnancy?

4 Answers available

Is it safe to use quinacrine in SLE patients with a history of hydroxychloroquine-associated retinopathy?

3 Answers available

How do you manage recurrent urticarial lesions in a patient with underlying connective tissue disease that is otherwise well-controlled?

3 Answers available

What is your approach to severe discoid lupus refractory to conventional topical and systemic therapies?

(Refractory to mycophenolate, azathioprine, and methotrexate. UpToDate suggests thalidomide or IVIG with mixed efficacy, while there are some case rep...

5 Answers available

What is your approach to using medications that can cause bone marrow suppression in SLE patients who have persistent leukopenia?

3 Answers available

How would you approach immunomodulatory treatment for systemic lupus associated protein losing enteropathy (PLE) in a patient whose clinical course has been complicated by significant infection?

Additionally, is it correct to assume that IV therapies might be preferred vs oral treatment given alterations in GI absorption in PLE?

1 Answer available

Have you seen drug induced SCLE from IL-17 inhibitors?

And if so, what is your approach to the diagnosis?

1 Answer available

Would you consider utilizing a TNF-inhibitor in a patient with RA/SLE overlap who has already tried methotrexate, hydroxychloroquine, and abatacept?

Female patient in her 20's with RA/SLE has been on steroids and methotrexate, currently on HCQ and Orencia. Failing Orencia with active disease. Want ...

4 Answers available

How do you approach “clearing” a patient with SLE and ESRD for renal transplant?

A specific example would be a clinically quiescent but serologically active patient.

1 Answer available

Would you stop belimumab in a patient with SLE starting ravulizumab (C5 inhibitor) for myasthenia gravis due to concern for additive immunosuppression?

3 Answers available

Are there concerns with using sulfasalazine in SLE?

Extrapolating from reactions with other sulfa medications potentially causes flares.

1 Answer available

How do you monitor patients with cutaneous lupus for progression to SLE?

Do you do blood work? Or do you rely on review of systems?

1 Answer available

Is there practical utility from obtaining CSF autoantibodies in patients with suspected neuropsychiatric systemic lupus erythematosus?

1 Answer available

What is your approach to monitoring a patient with SLE who has persistent hypocomplementemia on hydroxychloroquine, but clinically has resolution of cutaneous symptoms and no other internal organ manifestations of disease?

(C3 just below normal, C4 undetectable)

2 Answers available

What is your workup for CSF studies when evaluating for possible CNS Lupus?

In addition, what formula do you use to calculate the IgG index?

2 Answers available

How do you approach treating patients with lupus profundus?

Do you typically start the patient on hydroxychloroquine? What work-up do you perform?

1 Answer available

What is your approach to pharmacologic treatment options in a patient with both SLE and Crohn's disease?

A female in her 50s with iatrogenic Cushing's Syndrome presenting for management of SLE with low disease activity (but not remission) in the setting o...

1 Answer available

Would you escalate treatment for a clinically stable/asymptomatic lupus patient with persistent leukopenia/neutropenia, already on hydroxychloroquine?

6 Answers available

What would be your approach to a SLE patient who is triple APS positive, has no prior VTE/obstetric events, is stable on HCQ and low dose aspirin, and wants to become pregnant?

2 Answers available

When prescribing hydroxychloroquine, how do you explain the mechanism of action and how this translates into clinical benefit for the patient?

There are studies that show hydroxychloroquine inhibits autophagy (the orderly degradation and recycling of the contents of the cytoplasm for the cell...

3 Answers available

How would you approach a patient who has well controlled SLE on HCQ but develops cotton wool spots on routine ophthalmologic screening?

3 Answers available

What is your approach to assessing whether oral/nasal ulcerations are features of systemic lupus erythematosus versus from another etiology?

Classically, lupus mouth ulcers are large non-painful blisters at the roof of the mouth. What do you do with small scattered blisters, painful or not ...

1 Answer available

What is your approach to further work-up and management of neutropenia in patients with SLE/RA overlap?

For example, a patient with a bone marrow biopsy that shows normocellular bone marrow. Prior management with leflunomide and HCQ with neutropenia attr...

2 Answers available

Would you use TNF inhibitors in patients with features of SLE, but active peripheral and axial spondylarthritis?

Patient with sacroiliitis on imaging, failure of two NSAIDs.

2 Answers available

What is your approach to discordant dsDNA testing, such as positivity to dsDNA by crithidia but negativity to dsDNA by other modalities?

I get a lot of low false positive ds dna (sometimes high- 300) in quest and labcorp but their crithidia specific dsDNA labs when repeated are ne...

1 Answer available

Do you ever consider discontinuing hydroxychloroquine in patients with SLE in longstanding remission except in cases of overt toxicity?

This question is part of a collaboration with RheumMadness and is specifically in reference to: Hydroxychloroquine Withdrawal.

2 Answers available

How would you interpret a positive dsDNA in a patient with a negative ANA performed via indirect immunofluorescence?

4 Answers available

What is your approach to checking IgG levels post vaccination to detect common variable immunodeficiency in patients with systemic lupus?

If a deficiency is present, do you consider IVIG to treat non-infectious symptoms such as skin rash, arthritis or hematological abnormalities?

1 Answer available

Is there a role for hydroxychloroquine for secondary prevention in patients with APS without SLE?

1 Answer available

How do you manage recurrent inflammatory pleural effusions in lupus pleuritis?

1 Answer available

Is there a role for measuring serum mycophenolate mofetil levels (or its active metabolite) in the management of lupus nephritis?

1 Answer available

Do you measure drug levels (particularly hydroxychloroquine or mycophenolate) in your lupus patients?

Several speakers at ACR 2021 commented on the important role of drug levels in the management of these patients and cautioned against adding medicatio...

1 Answer available

Are there any major differences in clinical manifestations or autoantibody profiles in children with SLE based on ethnicity?

2 Answers available

Would you consider using DOACs in a young patient with SLE and Libman-Sacks endocarditis, who is negative for APS?

2 Answers available

Do you routinely monitor the QTc when adding voclosporin to hydroxychloroquine in a patient with lupus nephritis?

1 Answer available

Would you consider use of belimumab in a patient with SLE with recurrent anterior uveitis who failed other treatment options?

Patient failed topical ocular therapies, methotrexate, azathioprine.

2 Answers available

What do you use for treatment induction in pure class V lupus nephritis with nephrotic-range proteinuria when MMF is contraindicated?

2 Answers available

In which clinical scenarios is relying on the urine protein-to-creatinine ratio as a measure of proteinuria unreliable, and interpretations should be made looking at urine protein and urine creatinine separately?

1 Answer available

What are some explanations for the persistent renal outcome disparity gaps affecting certain minority groups of patients with pediatric SLE despite improvement in overall renal outcomes?

What would you suggest to help address these disparities in our own practices?

2 Answers available

How can ethnic representation in clinical research studies in childhood and adult SLE be improved?

This question is part of a collaboration with RheumMadness and is specifically in reference to: EMBRACE

2 Answers available

What are the reasons for SLE specific labs to turn negative?

Patients frequently mention diagnosis of SLE years ago but recent Sm, dsDNA (crithidia) and complements can be normal. Can treatment with medications ...

5 Answers available

How do you approach recurrent costochondritis in an SLE patient with nephritis who is otherwise controlled on MMF and HCQ but can't take NSAIDs?

2 Answers available

How would you approach the treatment of a patient who, during a hospitalization, was initially diagnosed with TTP and treated with PLEX with good response, but renal biopsy then resulted class IV LN along with changes of thrombotic microangiopathy?

4 Answers available

What is your treatment approach to persistent chillblains lesions in the absence of systemic lupus?

1 Answer available

What is your approach to the diagnosis and management of lupus cystitis?

2 Answers available

Are whole blood hydroxychloroquine blood levels helpful in patients taking chloroquine?

And if so, are the target levels similar?

2 Answers available

Do you routinely check G6PD level prior to initiation of hydroxychloroquine?

6 Answers available

How would you treat a patient with active lupus nephritis (class 3/4) who requires PD-1 immunotherapy for refractory metastatic renal cell carcinoma?

2 Answers available

In patients with lupus nephritis on maintenance therapy, is there additional benefit in utilizing 2 grams vs 3 grams of mycophenolate mofetil (MMF) daily?

3 Answers available

Is there a role for low dose aspirin in a patient with AVN in four large joints who has underlying well-controlled SLE and positive APLs but no history of clots?

1 Answer available

How do you approach the continued use of TNF inhibitors in a patient with inflammatory arthritis who develops a positive dsDNA without clinical evidence of drug-induced lupus?

2 Answers available

How would you approach initiating belimumab in a patient with serologic evidence of prior hepatitis B infection?

Such as patients with negative Hepatitis B surface antigen and negative viral load but with positive hepatitis b core antibody.

1 Answer available

What is your approach to ongoing assessment and medication tapering in well controlled discoid lupus without systemic features?

3 Answers available

How long would you consider the use of low-dose aspirin in a patient with SLE and high risk aPL profile (without a clinical event)?

1 Answer available

How do you approach the treatment of bullous cutaneous lupus?

When would you de-escalate therapy?

1 Answer available

What is your approach to management of ongoing scleritis in SLE despite mycophenolate?

1 Answer available

What is your approach to using NIH activity and chronicity indices from renal biopsy in tailoring immunosuppression to a patient with new lupus nephritis?

3 Answers available

Would you consider adding voclosporin to belimumab and MMF in the setting of active proteinuria, rather than switching agents?

3 Answers available

In your experience, is there an association between interstitial cystitis and systemic lupus erythematosus?

2 Answers available

What workup and initial treatment should be considered for suspected autoimmune myelofibrosis?

1 Answer available

Would you consider PLEX for patients with DAH from SLE-associated capillaritis?

1 Answer available

What have you found effective for the chronic fatigue that is often seen in patients with SLE or Sjogren's despite overall good disease control?

1 Answer available

Would you consider anifrolumab in the management of hematologic manifestations in SLE?

2 Answers available

Would you target the same hydroxychloroquine blood level for discoid lupus compared to systemic lupus?

1 Answer available

Do you escalate treatment for reactive lymphadenopathy in an otherwise stable and asymptomatic patient with lupus?

(assuming that the malignancy evaluation has been completed and the lymphadenopathy is confirmed to be reactive)

1 Answer available

How do you use hydroxychloroquine in patients with lupus nephritis on hemodialysis or peritoneal dialysis?

2 Answers available

Would you have any hesitation to use belimumab in a patient with IgA deficiency?

1 Answer available

Do you have any hesitations for combining belimumab with any of the DMARDs in patients with SLE/RA overlap?

2 Answers available

How do you differentiate a lupus flare versus drug-induced lupus in patients with SLE on a drug associated with DILE?

2 Answers available

Do you find IgA isotypes of anti-beta2-glycoprotein antibodies and anticardiolipin antibodies to be clinically useful in the evaluation for APS?

Do you routinely check IgA anticardiolipin and beta-2 glycoprotein antibody IgA in your practice? And how would a positive result change your manageme...

2 Answers available

How do you treat lupus-associated small fiber neuropathy?

1 Answer available

What do you view as reasonable alternatives to cyclophosphamide in the treatment of neuropsychiatric lupus?

4 Answers available

Do you ever consider treatment outside of the peripartum period in a patient with a history of obstetric APS?

i.e. obstretric APS without thrombosis or SLE

2 Answers available

How do you approach the management of immunosuppression in patients with lupus nephritis that go on to dialysis?

3 Answers available

What is your approach to treating severe manifestations of neuropsychiatric SLE in the setting of concomitant infection?

1 Answer available

Is there a role for immunosuppression in patients with triple positive antiphospholipid antibodies who do not meet the clinical criteria for APS?

2 Answers available

What particular pre-operative considerations should we consider for SLE patients undergoing elective surgery?

1 Answer available

How do you approach DMARD therapy in a patient with lupus and recurrent pericarditis?

1 Answer available

How do you approach the use of commercial testing such as AVISE CTD in clinical practice?

1 Answer available

How do you approach immunosuppressive therapy in lupus-associated pulmonary arterial hypertension?

2 Answers available

How do you clinically distinguish between cutaneous lupus with photosensitivity and polymorphic light eruption-like reactions?

1 Answer available

Is it ever reasonable to switch to a different TNFi as opposed to switching to an agent in a different class in a case of TNFi induced lupus or psoriasis?

In other words, do we think of TNFi induced lupus and TNFi induced psoriasis as a drug effect or a class effect?

1 Answer available

What is your approach to differentiating SLE flare in pregnancy vs pre-eclampsia?

1 Answer available

What is your approach to monitoring lipids in patients with rheumatic diseases such as RA and SLE and do you have a lower threshold to start lipid lowering agents compared to the general population?

2 Answers available

Does the presence of ANCA antibodies in patients with newly diagnosed lupus nephritis alter your approach to management?

1 Answer available

How would you approach localized lymphadenopathy in a patient with lupus whose symptoms are otherwise well-controlled?

2 Answers available

How do you approach monitoring of patients found to have a positive anti-dsDNA antibody without other clinical evidence of SLE?

1 Answer available

How would you advise patients with known stable autoimmune thrombocytopenia regarding the Ad26.COV2.S (Johnson & Johnson/Janssen) vaccine?

1 Answer available

How do you approach the use of low-dose aspirin for primary prevention in non-pregnant patients with SLE and positive aPL antibodies, without clinical criteria for APS?

Do you follow the 2019 EULAR Guidelines that SLE patients with asymptomatic, positive aPL should be on low-dose ASA?

1 Answer available

How useful are anti-ribosomal P antibodies in the evaluation for SLE psychosis?

1 Answer available

When is it necessary to monitor the QTc interval in patients on hydroxychloroquine?

2 Answers available

Is it okay to use medications associated with drug-induced lupus in patients with SLE?

1 Answer available

Is there a role for G-CSF treatment for SLE patients with persistent neutropenia?

1 Answer available

What is your approach to treatment of lupus peritonitis?

1 Answer available

Is there a role for measuring hydroxychloroquine blood levels in clinical practice?

If so, are there specific patient populations for which you would use this metric?

1 Answer available

What is your threshold for pursuing bone marrow biopsy in a lupus patient with cytopenias?

2 Answers available

Are you recommending the mRNA COVID-19 vaccines to your patients with immune mediated inflammatory diseases?

5 Answers available

What is your approach to treating refractory thrombocytopenia in lupus?

2 Answers available

Which immunosuppressed patients with SLE would benefit from antibiotic prophylaxis to prevent pneumocystis pneumonia?

1 Answer available

Is it ever appropriate to use hydroxychloroquine temporarily in higher doses (more than 5mg/kg) to control lupus activity such as skin manifestations?

1 Answer available

How do you interpret a high positive RNP in the setting of a negative ANA and negative sm/RNP?

To my understanding, sm/RNP should also be positive in this situation (and one would assume a positive ANA as well)

1 Answer available

How would you attempt to determine the etiology of intracranial hemorrhage in a patient with newly diagnosed lupus and an active viral infection?

1 Answer available

What is your first choice contraceptive agent for women with SLE?

How do you counsel these patients about hormonal agents?

1 Answer available

Is it okay to use belimumab to treat SLE in a patient who has a history of lymphoma and is on a Bruton's tyrosine kinase inhibitor (such as ibrutinib)?

1 Answer available

Do you think there is a role for belimumab in treating lupus nephritis and if so, in which patients would you considering adding it on?

Did the recently published BLISS-LN trial change your practice?

2 Answers available

Does serologic activity (e.g., high titer dsDNA, low complements) without clinical disease activity in a pregnant lupus patient affect maternal or fetal outcomes?

2 Answers available

Do you continue hydroxychloroquine in lupus patients who develop cardiomyopathy?

1 Answer available

Should gonadotropin-releasing hormone (GnRH) agonists be offered to all women of reproductive age about to undergo treatment with cyclophosphamide?

2 Answers available

What is your approach to bladder cancer surveillance in patients who have received cyclophosphamide?

1 Answer available

How do steroids and/or DMARDs affect biopsy results if a renal biopsy for suspected lupus nephritis is delayed?

1 Answer available

Are there any clinical situations in which checking for anti-chromatin antibodies is helpful?

1 Answer available

How do you counsel patients who ask if there are any dietary modifications they can make to help control their autoimmune disease?

This question is part of a collaboration with RheumMadness and is specifically in reference to: ADIRA Diet

1 Answer available

Is there a minimum work-up necessary in patients with an ANA greater than 1:160 and no clinical symptoms suggestive of lupus (i.e., specific antibodies, UA)?

2 Answers available

Do you use hydroxychloroquine for prevention of neonatal lupus in patients with a positive SSA who are planning on becoming pregnant?

1 Answer available

In the treatment of lupus nephritis, which patients may benefit from the use of rituximab or other B-cell depleting agents during induction?

1 Answer available

Papers discussed in this category

Arthritis and rheumatism, 2012-04

Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study.

Ann Rheum Dis, 2013 Jun 05

Prospective observational single-centre cohort study to evaluate the effectiveness of treating lupus nephritis with rituximab and mycophenolate mofetil but no oral steroids.

Arthritis and rheumatism, 2005-09

Use of a gonadotropin-releasing hormone analog for protection against premature ovarian failure during cyclophosphamide therapy in women with severe lupus.

Arthritis & rheumatology (Hoboken, N.J.), 2015-05

Randomized, double-blind, dose-escalation trial of triptorelin for ovary protection in childhood-onset systemic lupus erythematosus.

Lupus,

Preservation of fertility and ovarian function and minimizing gonadotoxicity in young women with systemic lupus erythematosus treated by chemotherapy.

Best Pract Res Clin Obstet Gynaecol, 2019 Nov 13

Ovarian protection with gonadotropin-releasing hormone agonists during cyclophosphamide therapy in systemic lupus erythematosus.

J. Am. Coll. Cardiol.,

Hydroxychloroquine to Prevent Recurrent Congenital Heart Block in Fetuses of Anti-SSA/Ro-Positive Mothers.

Arthritis and rheumatism, 1982-11

The 1982 revised criteria for the classification of systemic lupus erythematosus.

Arthritis and rheumatism, 2012-08

Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus.

, 2019 Aug 06

2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus.

Arthritis Rheum.,

Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.

Arthritis and rheumatism, 2010-01

Incidence and prevention of bladder toxicity from cyclophosphamide in the treatment of rheumatic diseases: a data-driven review.

J. Rheumatol., 2019 Sep 01

Malignancies in Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitis: A Population-based Cohort Study.

N Engl J Med,

Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis.

Southern medical journal, 2016-11

Effects of Statin Therapy in Patients with Systemic Lupus Erythematosus.

Annals of the rheumatic diseases, 2011-05

Lupus Atherosclerosis Prevention Study (LAPS).

Atherosclerosis, 2015 Aug 28

Statin reduces mortality and morbidity in systemic lupus erythematosus patients with hyperlipidemia: A nationwide population-based cohort study.

JAMA ophthalmology, 2014-12

The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy.

Can J Ophthalmol,

Retinal toxicity of high-dose hydroxychloroquine in patients with chronic graft-versus-host disease.

J Am Acad Dermatol, 2016 Feb 03

The effect of increasing the dose of hydroxychloroquine (HCQ) in patients with refractory cutaneous lupus erythematosus (CLE): An open-label prospective pilot study.

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2008-10

Prophylactic antibiotic usage for Pneumocystis jirovecii pneumonia in patients with systemic lupus erythematosus on cyclophosphamide: a survey of US rheumatologists and the review of literature.

Clin Rheumatol, 2006 Dec 21

Blood, 2015 May 13

A novel triple therapy for ITP using high-dose dexamethasone, low-dose rituximab, and cyclosporine (TT4).

Blood, 2009 Nov 06

Combination immunosuppressant therapy for patients with chronic refractory immune thrombocytopenic purpura.

Annals of the rheumatic diseases, 2011-10

Autoantibodies as biomarkers for the prediction of neuropsychiatric events in systemic lupus erythematosus.

Arthritis Rheum,

Accuracy of anti-ribosomal P protein antibody testing for the diagnosis of neuropsychiatric systemic lupus erythematosus: an international meta-analysis.

Rheumatol Int, 2019 Apr 30

Indications for bone marrow examinations in rheumatology.

Clin Exp Rheumatol, 2012 Sep 25

Indications for bone marrow examination in autoimmune disorders with concurrent haematologic alterations.

Wien Klin Wochenschr,

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Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus.

Cureus, 2019 Aug 19

Aseptic Meningitis and Depression: The Neuropsychiatric Manifestations of a Patient with Systemic Lupus Erythematosus.

J Rheumatol, 2007 Sep 15

Diagnostic reliability of cerebral spinal fluid tests for acute confusional state (delirium) in patients with systemic lupus erythematosus: interleukin 6 (IL-6), IL-8, interferon-alpha, IgG index, and Q-albumin.

Rheumatol Int, 2007 Jul 20

Acute psychosis in systemic lupus erythematosus.

Lupus, 2017 Feb 26

Central nervous system vasculitis in systemic lupus erythematosus: a case series report in a tertiary referral centre.

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2017 Mar-Apr

Biopsy of small kidneys: A safe and a useful guide to potentially treatable kidney disease.

Clinical journal of the American Society of Nephrology : CJASN, 2017 May 04

Clinical and Histopathologic Characteristics Associated with Renal Outcomes in Lupus Nephritis.

Seminars in arthritis and rheumatism, 2016 Sep 21

The utility of lupus serology in predicting outcomes of renal transplantation in lupus patients: Systematic literature review and analysis of the Toronto lupus cohort.

Clinical rheumatology, 2018 May 11

Impact of pre-transplant time on dialysis on survival in patients with lupus nephritis.

Nature communications, 2021 Jun 07

Phase 1 double-blind randomized safety trial of the Janus kinase inhibitor tofacitinib in systemic lupus erythematosus.

Lancet (London, England), 2023 Feb 24

Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 3 trial (SLE-BRAVE-I).

Lancet (London, England), 2023 Feb 24

Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 3 trial (SLE-BRAVE-II).

Clinical and experimental dermatology, 2021 Mar 09

Brodalumab-induced subacute cutaneous lupus erythematosus.

JAAD case reports, 2019 Mar 01

Ustekinumab-induced subacute cutaneous lupus.

Dermatologic therapy, 2020 May 03

Secukinumab-induced subacute cutaneous lupus erythematosus.

BMC nephrology, 2019 Oct 31

Clinical practice guideline on pregnancy and renal disease.

Rheumatology international, 2011 Feb 23

Lupus protein-losing enteropathy (LUPLE): a systematic review.

Arthritis & rheumatology (Hoboken, N.J.), 2023 Jun 01

Comparative Risks of Infection With Belimumab Versus Oral Immunosuppressants in Patients With Nonrenal Systemic Lupus Erythematosus.

Arthritis care & research, 2016 Jan

Vitamin D Supplementation in Adolescents and Young Adults With Juvenile Systemic Lupus Erythematosus for Improvement in Disease Activity and Fatigue Scores: A Randomized, Double-Blind, Placebo-Controlled Trial.

Lupus, 2014 Feb 06

Vitamin D and cutaneous lupus erythematosus: effect of vitamin D replacement on disease severity.

Lupus, 2019-05

Photosensitivity and photoprotection in patients with lupus erythematosus.

Journal of the American Academy of Dermatology, 2020 Apr 28

Cosmetic treatment in patients with autoimmune connective tissue diseases: Best practices for patients with lupus erythematosus.

The British journal of dermatology, 2003 Jul

Photosensitivity in patients with lupus erythematosus: a clinical and photobiological study of 100 patients using a prolonged phototest protocol.

Lupus, 2018 Oct 05

Resolution of large aortic valve vegetations in antiphospholipid syndrome treated with therapeutic anticoagulation: a report of two cases and literature review.

Journal of the American Academy of Dermatology, 2017 Oct 06

Antimalarial drug toxicities in patients with cutaneous lupus and dermatomyositis: A retrospective cohort study.

Annals of the rheumatic diseases, 2023 Oct 12

EULAR recommendations for the management of systemic lupus erythematosus: 2023 update.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2013 Jun 19

Severe lupus nephritis: the predictive value of a ≥ 50% reduction in proteinuria at 6 months.

Clinical journal of the American Society of Nephrology : CJASN, 2020 Mar 09

The Evolving Role of Calcineurin Inhibitors in Treating Lupus Nephritis.

Kidney international, 2021 Apr 18

A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy.

The New England journal of medicine, 2022 Nov 04

Empagliflozin in Patients with Chronic Kidney Disease.

Lupus science & medicine, 2020 Feb 18

Prediction of prognosis and renal outcome in lupus nephritis.

Arthritis Care Res (Hoboken), 2021 Mar 30

Clinical Significance of Monitoring Hydroxychloroquine Levels in Patients With Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis.

Lupus science & medicine, 2023 Nov 22