What is your approach to refractory oral ulcers in SLE?

For example, patient not responding to hydroxychloroquine and clobetasol gel, with biopsy which confirmed lupus mucositis

Answer from: at Academic Institution

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.

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at Duke University Medical Center
Forgot to mention this patient is also on MMF (so ...

Answer from: at Community Practice

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.

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What is your approach to refractory oral ulcers in SLE?

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