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?  

I do the following: I reassure them it is not cardiac or pulmonary. If I'm not 100% sure, then I send to cardiology (especially in my high-risk patients) because patients can occasionally chest wall tenderness for non-musculoskeletal chest pain. Ask them to work on proper posture (I'm convinced ...

I agree with Dr. @Thomas, but I do not use 40 mg of steroids, I use 20 mg. Also, I try to avoid atrophy or hypopigmentation in those areas with poor subcutaneous fatty tissues.