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Topics:
Internal Medicine • Rheumatology • Systemic lupus erythematosus • Inflammatory Bowel Disease • Gastroenterology • Dermatology
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. She also has a positive RF, smooth muscle antibody, and was diagnosed with Crohn’s disease based on colonoscopy/biopsy.
Answer from: at Academic Institution
This is not likely Crohn's disease but just a GI manifestation of this systemic autoimmune condition (more like a Behcet's type deal). Unless the GI stuff was first and then the diagnosis of SLE was made? Sounds like they might need an anti-TNF.
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Answer from: at Academic Institution
Obviously a very difficult patient. I have had some success using Otezla for mucocutaneous ulcers when all else has failed. Not sure it would have much impact on the lichenoid skin eruption, although it is somewhat effective in psoriasis. Colchicine may also help if it has not been used previously.
Answer from: at Community Practice
For this patient, I'd want more information regarding the SLE/rash component:
Whenever I see "lichenoid," in a lupus patient, I immediately wonder if it could be an anti-malarial reaction rather than be due to a "nonspecific" cutaneous lupus rash. The same goes for mucosal lesions, since they...