Treatment of SLE with Active Neuropsychiatric Inflammatory Manifestations
This protocol covers active neuropsychiatric systemic lupus erythematosus where the presenting manifestations — such as myelopathy or acute confusional state — are inflammatory in origin, and where atherothrombotic or antiphospholipid antibody-related neuropsychiatric causes have been excluded.
Clinical Scenario
Active neuropsychiatric SLE with inflammatory manifestations (e.g. myelopathy, acute confusional state), confirmed absence of atherothrombotic or antiphospholipid antibody-related neuropsychiatric manifestations.
Treatment Approach — Partial Overview
Management is built around glucocorticoids and immunosuppressive therapy. The choice of immunosuppressive agent is guided by the severity of the neuropsychiatric presentation.
Specific agent selection, escalation criteria, and the full regimen are detailed in the structured protocol →
References
- In active neuropsychiatric disease attributed to SLE, glucocorticoids and immunosuppressive agents for inflammatory manifestations (1b/A) and antiplatelet agents/anticoagulants for atherothrombotic/aPL-related manifestations (2b/C) should be considered.
- For severe inflammatory manifestations (eg, myelopathy, acute confusional state), potent immunosuppressive agents, like CYC or RTX, should be preferred.
DOI: 10.1136/ard-2023-224762
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