What is the first-line therapy for a flare of SLE?

What is the first-line therapy for a flare of SLE?

• A. Steroids
• B. Hydroxychloroquine
• C. Azathioprine
• D. Cyclophosphamide

Answer: (A)

When an SLE flare occurs, the body’s inflammation needs to be knocked down quickly. Glucocorticoids do this best because they rapidly suppress the wide range of immune and inflammatory pathways driving the flare. A high-dose steroid rapidly improves symptoms and protects organs, and then the dose can be tapered as the flare comes under control. Hydroxychloroquine, while essential for long-term disease control and for reducing future flares, works more slowly and isn’t the fastest way to treat an active flare. Immunosuppressants like azathioprine or cyclophosphamide are used for more severe or organ-threatening disease and often after steroids are started, or when steroids alone aren’t enough; they have slower onset and higher toxicity, so they aren’t first-line for an acute flare.

When an SLE flare occurs, the body’s inflammation needs to be knocked down quickly. Glucocorticoids do this best because they rapidly suppress the wide range of immune and inflammatory pathways driving the flare. A high-dose steroid rapidly improves symptoms and protects organs, and then the dose can be tapered as the flare comes under control.

Hydroxychloroquine, while essential for long-term disease control and for reducing future flares, works more slowly and isn’t the fastest way to treat an active flare. Immunosuppressants like azathioprine or cyclophosphamide are used for more severe or organ-threatening disease and often after steroids are started, or when steroids alone aren’t enough; they have slower onset and higher toxicity, so they aren’t first-line for an acute flare.