Mild SLE Without Renal Involvement: What to Do When Methotrexate, Azathioprine, or Mycophenolate Has Not Controlled Disease
This protocol applies to mild, non-renal systemic lupus erythematosus where an immunosuppressive agent added in the prior treatment step has not brought disease activity to remission or low disease activity state.
Clinical scenario
Mild SLE without renal involvement: constitutional symptoms, mild arthritis, rash affecting no more than 9% of body surface area, platelet count 50–100 × 10&sup9;/L, SLEDAI ≤6, and BILAG C or no more than one BILAG B manifestation.
Previous treatment step — targets not met
The prior line involved the addition of
methotrexate, azathioprine, or mycophenolate. This protocol is indicated when that step has not achieved a SLEDAI score of 0 (remission) or a SLEDAI ≤4 (low disease activity state).
Next treatment approach (partial)
When the above immunosuppressive agents have failed to reach targets, the protocol calls for the addition of a
targeted biological agent. The full selection, criteria, and approach are available in the complete protocol.
Treatment goals: SLEDAI score of 0 (remission) or SLEDAI ≤4 (low disease activity state).
References
DOI: 10.1136/ard-2023-224762
Mild disease: constitutional symptoms; mild arthritis; rash ≤9% body surface area; platelet count (PLTs) 50–100 × 10&sup9;/L; SLEDAI≤6; BILAG C or ≤1 BILAG B manifestation.
In patients not responding to hydroxychloroquine (alone or in combination with glucocorticoids) or patients unable to reduce glucocorticoids below doses acceptable for chronic use, addition of immunomodulating/immunosuppressive agents (eg, methotrexate (1b/B), azathioprine (2b/C) or mycophenolate (2a/B)) and/or biological agents (eg, belimumab (1a/A) or anifrolumab (1a/A)) should be considered.
View source ↗