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