From the Guidelines
Treatment for a lupus flare should prioritize minimizing disease activity and preventing flares, with hydroxychloroquine recommended for all patients at a dose not exceeding 5 mg/kg real body weight, and corticosteroids used judiciously to reduce inflammation while minimizing long-term exposure. According to the 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus 1, the goal of treatment is to achieve remission or low disease activity, which can help prevent damage accrual and improve quality of life.
For mild to moderate flares, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen may be used to manage joint pain and inflammation. Antimalarials such as hydroxychloroquine are often used as baseline therapy to prevent flares and should be continued during treatment 1. The daily dose of hydroxychloroquine should not exceed 5 mg/kg real body weight to minimize the risk of retinal toxicity.
For more severe flares, corticosteroids like prednisone may be prescribed to quickly reduce inflammation, with the aim of minimizing the dose and duration of treatment to reduce the risk of side effects. Immunosuppressants such as mycophenolate mofetil, azathioprine, or cyclophosphamide may be added for organ-threatening disease, and belimumab may be considered for persistent disease activity.
Key considerations in managing lupus flares include:
- Minimizing disease activity and preventing flares
- Using hydroxychloroquine as baseline therapy
- Judicious use of corticosteroids to reduce inflammation while minimizing long-term exposure
- Considering immunosuppressants and biologic medications for severe or persistent disease activity
- Regular communication with healthcare providers to adjust treatment as needed, as recommended by the EULAR guidelines 1.
From the FDA Drug Label
For the treatment of systemic lupus erythematosus in adults. Hydroxychloroquine sulfate tablets are indicated for the treatment of systemic lupus erythematosus in adults. The treatment for a lupus flare includes hydroxychloroquine 2.
- Key points:
- Hydroxychloroquine is used for the treatment of systemic lupus erythematosus in adults.
- It can be used to manage lupus flares. Note that belimumab 3 is also used in the treatment of SLE, but the provided text does not directly answer the question of lupus flare treatment.
From the Research
Treatment Options for Lupus Flare
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat musculoskeletal symptoms, serositis, and headache in patients with systemic lupus erythematosus (SLE) 4
- Mycophenolate mofetil (MMF) has been shown to be effective in treating severe lupus nephritis, particularly in patients who are refractory to cyclophosphamide or have relapsing disease 5, 6, 7
- Hydroxychloroquine (HCQ) is a mainstay long-term treatment in SLE, recommended by current guidelines in all patients unless contraindications or side effects, and has been shown to decrease SLE activity, prevent disease flare, and lower the long-term glucocorticoid need 8
Medication Considerations
- NSAIDs can induce renal side effects, including sodium retention and reduction of the glomerular filtration rate, and increase the risk of cutaneous and allergic reactions, as well as hepatotoxic effects 4
- MMF has been associated with a reduced risk of infection and amenorrhea compared to cyclophosphamide, but may cause more diarrhea 7
- HCQ has a significant favorable impact on long-term outcomes such as damage accrual and mortality in SLE, but the daily dose associated with the best compromise between efficacy and safety is a matter of debate 8
Disease Management
- Treatment of SLE with NSAIDs requires awareness of the increased frequency of some side effects and close monitoring of toxicity 4
- MMF may be a useful treatment for lupus nephritis, although available trial data are limited due to the small size of previous studies 7
- Early HCQ use in antinuclear antibodies positive individuals may delay the progression to SLE, and HCQ has antithrombotic and metabolic effects, including lipid-lowering properties 8