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.
A combination of prednisone and immunosuppressive drugs is recommended in active, serious CNS lupus or active reversible lupus nephritis. Improvement does not usually occur for 4 to 12 wk and may not be evident until corticosteroid dosage is reduced. Acute vasculitis and severe CNS lupus are treated with the same regimens as for renal damage, above. In situ thrombosis or embolism of cerebral, pulmonary, or placental vessels may require short-term treatment with heparin and longer term management with warfarin. Response to therapy is measured by relief of symptoms and signs or improvement in laboratory tests.