How is SLE in children treated
General
- • Counseling, education.
- • Adequate rest.
- • Use of sunscreens.
- • Immunizations, especially pneumococcal.
- • Management of infection.
Medications
- • Nonsteroidal antiinflammatory drugs (NSAIDs) for musculoskeletal signs and symptoms (caution if renal disease is present).
- • Hydroxychloroquine (5 mg/kg per day) for cutaneous disease and as adjunct to glucocorticoids (GCs) for systemic disease.
- • GCs
- • Oral prednisone, 1–2 mg/kg per day divided twice daily. Note that children metabolize GCs faster than adults.
- • Intravenous (IV) methylprednisolone (30 mg/kg per day; max 1 g) initially for severe disease.
- • Immunosuppressives
- • Azathioprine, 1–2 mg/kg per day divided twice daily.
- • Cyclophosphamide: oral 1–2 mg/kg per day; IV 500–1000 mg/m 2 per month or Euro-Lupus protocol (500 mg/m 2 every 2 weeks × six doses).
- • Mycophenolate mofetil, 1200 mg/m 2 per day divided twice daily (max 1000 mg twice a day).
- • Cyclosporine, 6 mg/kg per day divided twice daily (caution with renal disease and hypertension).
- • Anti-B-cell therapy: off label use of rituximab, belimumab (approved for use in adults with SLE).
- • Plasmapharesis: indicated for thrombotic thrombocytopenic purpura, catastrophic antiphospholipid syndrome (CAPS), transverse myelitis (antineuromyelitis optica).
- • Intravenous immunoglobulin: used for CAPS, macrophage activation syndrome (MAS), immune hemolytic anemia/thrombocytopenia.
- • Interleukin-1 inhibition: off label use of anakinra for MAS complicating SLE.
