A 28-year-old woman with newly diagnosed SLE presents with mild arthralgia, photosensitive rash, and positive ANA. She has normal renal function and no CNS involvement. What is the drug of choice for initial management?

Question

Accepted Answer

A. Hydroxychloroquine. ## First-Line Management of Mild-to-Moderate SLE

**Key Point:** Hydroxychloroquine is the cornerstone of SLE therapy and is recommended for ALL patients with SLE, regardless of disease severity, due to its efficacy, safety profile, and ability to reduce flares and mortality.

### Mechanism of Hydroxychloroquine
1. Increases lysosomal pH, reducing antigen presentation
2. Inhibits TLR signalling in dendritic cells
3. Reduces autoantibody production and immune complex deposition
4. Anti-inflammatory and anticoagulant properties

### Clinical Indications in SLE
- **Mild disease (cutaneous, articular):** Hydroxychloroquine ± NSAIDs
- **Moderate disease (systemic manifestations):** Hydroxychloroquine + low-dose corticosteroids
- **Severe disease (renal, CNS, vasculitis):** Hydroxychloroquine + corticosteroids + immunosuppressants

**High-Yield:** Hydroxychloroquine reduces SLE flare rate by ~50%, decreases thrombotic events, and improves long-term survival. It is safe in pregnancy (FDA Category C) and should be continued even during remission.

### Dosing
- Standard dose: 200–400 mg/day (6.5 mg/kg/day)
- Monitor baseline and annual ophthalmology (retinal toxicity risk after 5 years of use)

**Clinical Pearl:** Hydroxychloroquine has a slow onset (weeks to months) but is essential for disease control and is never omitted in SLE management.

### Why Other Agents Are Not First-Line

| Drug | Role in SLE | Why Not First-Line |
|------|-------------|--------------------|
| Cyclophosphamide | Severe lupus nephritis, CNS disease | Reserved for severe/refractory disease; significant toxicity (infertility, infection, malignancy) |
| Mycophenolate mofetil | Lupus nephritis (Class III–IV) | Second-line for renal disease; not for mild disease |
| Azathioprine | Maintenance therapy, steroid-sparing | Alternative to MMF; less effective than MMF for nephritis |

[cite:Harrison 21e Ch 319]

Answer

B. Cyclophosphamide

Answer

C. Mycophenolate mofetil

Answer

D. Azathioprine

A 28-year-old woman with newly diagnosed SLE presents with mild arthralgia, photosensitive rash, and positive ANA. She has normal renal function and no CNS involvement. What is the drug of choice for initial management?

Explanation

First-Line Management of Mild-to-Moderate SLE

Mechanism of Hydroxychloroquine

Clinical Indications in SLE

Dosing

Why Other Agents Are Not First-Line

Practice similar questions

Join our NEET PG community

Drug	Role in SLE	Why Not First-Line
Cyclophosphamide	Severe lupus nephritis, CNS disease	Reserved for severe/refractory disease; significant toxicity (infertility, infection, malignancy)
Mycophenolate mofetil	Lupus nephritis (Class III–IV)	Second-line for renal disease; not for mild disease
Azathioprine	Maintenance therapy, steroid-sparing	Alternative to MMF; less effective than MMF for nephritis