How would you treat active SLE with high level crithidia dsDNA abs and recurrent pleuritis with effusions still requiring corticosteroids despite combination therapy with full doses of mycophenolate, hydroxychloroquine, and Benlysta for over 6 months after no response to Saphnelo for 6 months?

There are no controlled trials of different therapies for treating refractory pleuritis in lupus as the primary manifestation. Due to refractory pleuritis being relatively uncommon, the trials of benlysta and anifrolumab did not have enough patients to assess response. In the literature, there are a...

To add to Dr. @Dr. First Last's excellent answer:

Treatment-resistant, recurrent pleural effusions after such good combination therapies as these would be highly unusual. Though anti-dsDNA Crithidia is positive, this does not necessarily mean the effusions/pleuritis are due to SLE. I have patients wi...

First, confirm this is genuinely refractory lupus serositis and not a mimic before escalating immunosuppression.

Assuming active lupus serositis is confirmed, I would escalate to an alternative biologic rather than increasing glucocorticoids. Since full-dose MMF has already failed, I would argue that...