ReviewHow to treat refractory arthritis in lupus?
Section snippets
Antimalarial drugs
Two synthetic antimalarial drugs have been authorised for use in the treatment of SLE: hydroxychloroquine and chloroquine. The most frequently used doses are 400 mg/day for hydroxychloroquine (≤ 6.5 mg/kg/day, to limit the risks of ocular toxicity) and 4 mg/kg/day for chloroquine. Recent data have implicated toll-like receptors in SLE and may represent further indirect evidence for a role of antimalarial drugs in the treatment of this auto-immune disease [6]. In a double-blind, prospective,
Corticosteroids
Low-dose corticosteroids are widely used in the treatment of SLE and its joint signs. The beneficial effects of such treatment were suggested, in particular, by a double-blind, prospective, randomised study comparing corticosteroids with placebo for the prevention of clinical relapses in 41 patients suffering from SLE with an isolated increase in markers of biological activity [10]. In the placebo group, there were six severe flare-ups, including three with joint symptoms, whereas no flare-ups
Methotrexate
Methotrexate is the molecule most studied for the treatment of joint symptoms associated with lupus. A double-blind, randomised study compared methotrexate (15–20 mg/week) with placebo over a period of 6 months, in 41 SLE patients; more than 80% of the patients presented arthralgia or arthritis, the frequencies of these conditions being similar in the two groups [11]. At the end of the study, 16 patients in the placebo group and one of the 18 patients in the group treated with methotrexate still
Other immunosuppressants
According to the PNDS guidelines published in 2009, the efficacy of other immunosuppressants (azathioprine, off-label mycophenolic acid, cyclophosphamide) against joint symptoms remains unproven [3].
Rituximab
Two large, double-blind, randomised studies have reported no significant benefits of rituximab in the treatment of extrarenal [22] or renal [23] signs of SLE. These results contrast with the results obtained in many open studies. However, neither of these two studies specifically reported findings for joint symptoms. The French AIR Registry has analysed the data of 136 patients with lupus who had been treated with rituximab [24]. Joint symptoms were present and evaluable in 50 of these patients
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
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Broad Concepts in Management of Systemic Lupus Erythematosus
2017, Mayo Clinic ProceedingsCitation Excerpt :Inflammatory arthritis is treated with judicious use of NSAIDs or prednisone (dose, 0.25-0.5 mg/kg) and HCQ. Inability to taper prednisone or persistent disease requires the addition of second-line immunosuppressive therapy such as methotrexate and MMF.26,27 Azathioprine, leflunomide, and cyclosporine are effective as well.
When biologics should be used in systemic lupus erythematosus?
2014, Presse MedicaleOverlap connective tissue disease syndromes
2013, Autoimmunity ReviewsCitation Excerpt :Fernandez et al. [82] found that erosive arthritis can be disabling and is poorly responsive to therapy. Treatment regimens are the same used to prevent the progression of erosive arthritis in RA, including corticosteroids, methotrexate and leflunomide [82,96,97]. The use of mycophenolate mofetil and cyclosporin A has been also reported to be effective in anecdotal cases [83,98].
Medical management of wrist and hand inflammatory conditions: A literature review
2019, Journal of Arthroscopy and Joint SurgeryCitation Excerpt :Methotrexate may be added to this regimen if low disease activity state or remission is not achieved with first line treatment options, as it has been shown to be effective in controlling articular symptoms and allowing reduction in steroid dose.26 Other therapeutic options that may be tried in the case of either intolerance or inadequate response to first- or second-line agents for arthritis include azathioprine, mycophenolate mofetil, leflunomide,27 rituximab,28 and belimumab.29 Belimumab has been found to improve arthritis in patients with SLE.
Mycophenolate mofetil in nonrenal manifestations of systemic lupus erythematosus: An observational cohort study
2016, Journal of Rheumatology