Best approaches for therapy in an SLE patient with arthritis who has no evidence of internal organ involvement

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What are the best approaches for therapy in an SLE patient with arthritis who has no evidence of internal organ involvement?

• The first line of therapy is nonseteroidal antiinflammatory drugs (NSAIDs). Cycloxoygenase-2 specific inhibitors may be used but may contribute to thrombotic risk in patients with antiphospholipid antibodies.

• Celecoxib is sulfa based and may lead to rashes as many patients with SLE react to sulfa-based therapies. Consider meloxicam or etodolac. Avoid ibuprofen if possible due to risk of causing aseptic meningitis.

• Antimalarial drugs can provide remarkable benefit including decreased risk of flares and decreased risk of developing end-organ damage.

• Other therapies: methotrexate, leflunomide, AZA, MMF

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