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?

Answer from: at Community Practice

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, @Cuoghi Edens for reminding me. :-) Wh...

Comments

at University of Chicago
You are presuming he is taking his HCQ, Don. Getti...

at Uniformed Services University of the Health Sciences (USUHS)
Oh, great point... I forgot to add my favorite str...

at University of Chicago
I deal with a lot of 'young' people (LOL). That's ...

at Uniformed Services University of the Health Sciences (USUHS)
Aim higher. You'll get better results. I have arou...

at University of Chicago
Higher level is higher risk for retinopathy, as Mi...

at Arthritis Associates
If he is taking his plaquenil, and levels are good...

at Uniformed Services University of the Health Sciences (USUHS)
@Cuoghi Edens: that is why I recommend 750 - 1200 ...

Answer from: at Academic Institution

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 tak...

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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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