A 30-year-old woman with SLE presents with pleuritic chest pain and shortness of breath. Chest X-ray shows bilateral small pleural effusions. Echocardiography reveals a pericardial effusion. Anti-dsDNA titre is markedly elevated and complement C3/C4 are low. Her current regimen is hydroxychloroquine. The most appropriate addition to her treatment is:
- A Methylprednisolone pulse followed by oral prednisolone with mycophenolate mofetil ✓
- B Colchicine alone for serositis
- C Cyclophosphamide IV induction immediately
- D Belimumab as first-line intensification
Correct answer: A. Methylprednisolone pulse followed by oral prednisolone with mycophenolate mofetil
Explanation
Active SLE serositis (pleuritis, pericarditis) with immunological activity (rising anti-dsDNA, low complement) indicates a flare requiring corticosteroid therapy. IV methylprednisolone followed by oral prednisolone is first-line, with mycophenolate added as a steroid-sparing agent for moderate disease. Cyclophosphamide is reserved for severe lupus nephritis or neuropsychiatric SLE. Belimumab is adjunctive therapy after inadequate response to standard immunosuppression.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.