From the Guidelines
Lupus flares should be managed with a combination of medications, including hydroxychloroquine, glucocorticoids, and immunosuppressants, with the goal of achieving remission or low disease activity and preventing future flares, as recommended by the 2019 EULAR guidelines 1. The management of lupus flares involves a multi-faceted approach, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for mild to moderate flares, and corticosteroids such as prednisone (5-60mg daily depending on severity) for more significant flares.
- Hydroxychloroquine is recommended for all patients with lupus, at a dose not exceeding 5 mg/kg real body weight, as it has been shown to reduce the risk of flares and improve long-term outcomes 1.
- Glucocorticoids should be minimized to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn, as they can have significant side effects and contribute to morbidity and mortality 1.
- Immunomodulatory agents such as methotrexate, azathioprine, or mycophenolate can be used to expedite the tapering or discontinuation of glucocorticoids and to maintain disease control 1.
- Biologics such as belimumab or rituximab may be considered for patients with inadequate response to standard therapy or with organ-threatening disease 1. It is essential to note that the management of lupus flares should be individualized, taking into account the severity of the flare, the presence of organ involvement, and the patient's overall health status and preferences.
- Patients with lupus should be assessed for their antiphospholipid antibody status, infectious and cardiovascular diseases risk profile, and preventative strategies should be tailored accordingly 1.
- During a flare, it is crucial to rest adequately, avoid sun exposure, manage stress, and stay hydrated, and to contact a healthcare provider if new or worsening symptoms occur, such as severe fatigue, joint pain, rash, fever, or chest pain.
From the Research
Definition and Management of Lupus Flare
- Lupus flare is a period of increased disease activity in patients with systemic lupus erythematosus (SLE) 2.
- The management of lupus flare involves the use of immunosuppressive medications, such as glucocorticoids, cyclophosphamide, mycophenolate mofetil, and calcineurin inhibitors 3.
- The goal of treatment is to reduce inflammation and prevent organ damage, while minimizing the risk of adverse effects 4.
Risk Factors for Lupus Flare
- Epidemiological and disease-related risk factors, such as low disease activity, can increase the risk of lupus flare 2.
- Clinical and immunological features, such as cytokine levels in serum and urine, may be useful in predicting flares, but require further research to be simple, easy, and cost-effective 2.
- Patients with a history of lupus nephritis may be at increased risk of renal flares, and require close monitoring and maintenance therapy 3.
Treatment Options for Lupus Flare
- Glucocorticoids, such as prednisolone, are commonly used to treat lupus flare, but may have significant side effects, such as infections, hypertension, and osteoporosis 4.
- Immunossuppressive medications, such as azathioprine, methotrexate, and mycophenolate mofetil, may be used as steroid-sparing agents, and have been shown to reduce the risk of flares and improve disease outcomes 5.
- Biological agents, such as belimumab, may be used in patients with active SLE, or recurrence of acute cutaneous lupus erythematosus (ACLE) during tapering of corticosteroids 6.