How do you manage a patient with severe RA or SLE that worsens after stopping immunosuppressants due to having chronic foot ulceration?  

Fear the foot ulcer! These portals of entry for microorganisms can wreak havoc in immune-compromised patients. Rheumatologists must ensure that these lesions are being properly managed. Since healing can often be prolonged in some of our patients, the decision of whether and when to resume immune su...

I agree with not using any steroids. IVIG has been used as an adjunct and off-label drug option in SLE when standard immunosuppressives are contraindicated and there's an active infection or SLE is refractory (Sakthiswary and D'Cruz, PMID 25310743). I may opt to use IVIG until the ulcer is resolved....