Version July 2025
IL: interleukin; IVIG: intravenous immunoglobulin; SLE: systemic lupus erythematosus.
* Unless there is a contraindication to its use, hydroxychloroquine is given to all patients with SLE regardless of whether they are pregnant. Dosing of hydroxychloroquine is not affected by pregnancy. For more information on dosing, please refer to UpToDate content on antimalarial drugs in the treatment of rheumatic disease.
¶ Check for thiopurine 5-methyltransferase (TPMT) deficiency prior to starting; refer to UpToDate content on the use of azathioprine in rheumatic diseases. Sulfasalazine may be used as an alternative to azathioprine in patients who predominately have arthritis.
Δ Intravenous pulse dose glucocorticoids (eg, methylprednisolone 1 g/day) may be indicated initially for severe flares. Patients with nephritis should receive >20 mg/day of prednisone. The exact dose depends on the specific disease manifestations; please refer to UpToDate content on the treatment of specific disease manifestations of SLE.
◊ Refer to UpToDate content on the treatment of specific disease manifestations in SLE and content on the safety of rheumatic disease medication use during pregnancy for more information, including drug dosing and monitoring. Safety data during pregnancy are limited for some agents listed.
§ Please refer to UpToDate topics on the specific disease manifestations of SLE.