What is your approach to refractory oral ulcers in SLE?

Would not consider only trying HCQ as being refractory. Many more lupus medications to be tried! Azathioprine, MMF, Methotrexate, and Benlysta would all be under consideration. I presume their labs show some aspect of active SLE.

Prior to availability of apremilast for psoriatic disease and Behcet disease (which can be effective if a case can be made for the patient accessing this), I found thalidomide to be very effective for this.