How would you approach the treatment of an SLE patient with refractory mucocutaneous ulcerations and lichenoid skin eruption despite treatment with MMF, Aza, Benlysta, Saphnelo, Rituximab, and JAK inhibitors?  

This is an interesting case and the co-occurrence of SLE and Crohn's disease is rare but not unprecedented. The first issue is if the mucocutaneous lesions are related to SLE or the IBD and oral lesions are well described in Crohn's disease. Second, although cutaneous manifestations of Crohn's disea...

For this patient, I'd want more information regarding the SLE/rash component: Whenever I see "lichenoid," in a lupus patient, I immediately wonder if it could be an anti-malarial lichenoid reaction rather than being due to a "nonspecific" cutaneous lupus rash. The same goes for mucosal lesions sinc...

Although it requires additional patient counseling, thalidomide or lenalidomide can be very effective in refractory cases and is often not considered, even though it's often effective and well tolerated at low doses.

Obviously a very difficult patient. I have had some success using Otezla for mucocutaneous ulcers when all else has failed. Not sure it would have much impact on the lichenoid skin eruption, although it is somewhat effective in psoriasis. Colchicine may also help if it has not been used previously.

This is not likely Crohn's disease but just a GI manifestation of this systemic autoimmune condition (more like a Behcet's type deal). Unless the GI stuff was first and then the diagnosis of SLE was made? Sounds like they might need an anti-TNF.

This is complex and nuanced information would be helpful to guide management. Saphnelo is anifrolumab which this patient presumably was on already. Important to know for how long this medication was used and if there was a response of clinical manifestations and particular biomarkers such as ferriti...

I like to look for possible underlying reversible issues such as his Vitamin D level, and I would seriously consider putting him on the ultimate exclusion carnivore diet consisting strictly of red ruminant meats, salt and water. This would eliminate any form of processed foods containing inflammator...

Although I have no personal experience with its use, I have heard that anifrolumab can turn disease off in 1-3 infusions. It helps with skin, mucosal, and joint disease. It is an infusion, and supposedly, it is safe in cancer patients and in those with renal disease.

I have such a patient who also is on peritoneal dialysis for end stage kidney disease. She had an exacerbation of her cutaneous lupus with erythema over the discoid lesions on her face and new lesions on her bilateral arms. A dermatology consult was obtained and she was started on monthly Anifroluma...