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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?
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2 Answers
Mednet Member
Rheumatology · Uniformed Services University of the Health Sciences (USUHS)
- First, is he taking his HCQ (55% chance he is not)? Check a trough whole blood HCQ drug level and you want it to be 1000 - 1200 ng/mL (that is my goal in uncontrolled lupus; 750 - 1200 is fine in lupus under remission per Garg et al., PMID 37667434). Thanks, @Dr. First Last for reminding me. :-)
- Wh...
Mednet Member
Rheumatology · University of Chicago
- I would definitely encourage tobacco cessation no matter what medication, not only for his skin but for overall health.
- I'd check HCQ levels to see if he is taking and/or therapeutic.
- Presuming he is not taking it/missing doses, I would start Saphnelo for increased compliance
- If he is taking would...