For which SLE manifestations or disease activity markers do you generally recommend escalation to a biologic in a patient who does not have apparent renal involvement?

For renal lupus, mycophenolate is no longer sufficient as induction therapy: either belimumab or calcineurin inhibitors should be added. For non-renal lupus, EULAR 2023 guidelines (Fanouriakis et al., PMID 37827694) state that immunosuppressives and/or biologics can be added. Gatto et al have shown ...

If the patient's skin disease, arthritis, pericarditis, mucosal disease, alopecia, etc., do not respond to mycophenylate, leflunomide, with plaquenil, then I will go with a biologic after 3 months of maximum therapy. I have a low threshold for starting belimumab due to its safety profile. I do treat...

The latest EULAR SLE management guidelines give fantastic, practical recommendations for this situation (Fanouriakis et al., PMID 37827694). I encourage every rheumatologist to download and keep handy Figure 1 from the article.

When you have that patient with SLE sitting in front of you, ask if the p...