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How would you manage a patient SLE who is planning pregnancy and has serologically active disease (elevated dsDNA, low C3/C4), mild arthritis, and is otherwise asymptomatic on hydroxychloroquine 200 mg BID and methotrexate 15 mg weekly?
She is aPL-negative.
Would you transition methotrexate to azathioprine or consider adding belimumab prior to conception?
Answer from: at Academic Institution
Options I'd consider would be sulfasalazine and/or azathioprine, as mentioned. I think the question is will SSZ+HCQ be enough for her SLE or will AZA+HCQ be enough for her arthritis? Could certainly add Belimumab to her HCQ, although it has a much longer onset of action and certainly less pregnancy ...
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