Treatment of Systemic Lupus Erythematosus in Women

First-Line Treatments

• The European League Against Rheumatism recommends hydroxychloroquine for all patients with SLE to reduce disease activity, flares, and mortality 1
• Antimalarials, such as hydroxychloroquine, are recommended preconceptionally and throughout pregnancy for all SLE patients, providing benefits for both maternal disease control and improved obstetrical outcomes 2, 3
• Glucocorticoids can be used for disease control but should be limited to the lowest effective dose due to long-term side effects; aim to reduce doses to ≤7.5 mg/day when possible 1, 4

Second-Line Treatments for Non-Responsive or Organ-Threatening Disease

• Immunosuppressive agents, such as azathioprine, mycophenolate mofetil, methotrexate, and cyclophosphamide, should be considered for patients who are not responsive to first-line therapy or unable to reduce steroids below acceptable doses for chronic use 1, 4, 5

Treatment Based on Organ Involvement

• For lupus nephritis, first-line treatment includes glucocorticoids plus mycophenolate mofetil or cyclophosphamide (induction), followed by maintenance with mycophenolate or azathioprine 5
• Regular monitoring of renal function, proteinuria, and urine sediment is essential for patients with lupus nephritis 1

Special Considerations for Women

• Preconception counseling and risk stratification are essential for women with SLE, with major risk factors for adverse pregnancy outcomes including active/flaring SLE, history of lupus nephritis, and presence of antiphospholipid antibodies 2, 6
• Hydroxychloroquine is recommended throughout pregnancy for women with SLE, and azathioprine and low-dose aspirin can also be used during pregnancy 3, 4, 7

Adjunctive Therapies

• Lifestyle modifications, such as smoking cessation, weight control, regular exercise, and sun protection, are important and should be encouraged for women with SLE 1, 5
• Preventive medications, such as low-dose aspirin, calcium and vitamin D supplementation, bisphosphonates, statins, and antihypertensives, should be considered based on individual risk factors 1, 3, 8