Flares are rare after menopause, although late-onset SLE does occur and may be difficult to diagnose. Treatment Management of idiopathic SLE depends on its manifestations and severity. The course is unpredictable. Mild or remittent disease may require little or no therapy. Aspirin is useful, especially in patients with the thrombotic tendency associated with anticardiolipin antibodies, but high doses in SLE may cause liver toxicity.
Antimalarials help, particularly when joint and skin manifestations are prominent.
Regimens vary, but hydroxychloroquine 200 mg po once or twice per day is preferred. Combinations of these drugs are sometimes used. Ophthalmologic examination usually is advised at 6-mo intervals, although this practice may be excessively cautious because these doses are modest and recent data suggest that hydroxychloroquine has very low retinal toxicity. Larger doses are less well-tolerated for their androgenic effect and are probably not more effective than the lower dose range. Severe disease requires immediate corticosteroid therapy.