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Shifting the Management Paradigm for SLE and Lupus Nephritis

Karen Costenbader, MD, MPH

The paradigm for treating patients with systemic lupus erythematosus (SLE) is rapidly shifting and our patients will surely benefit with improved outcomes.

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Steroids in Lupus Nephritis: No Free Lunch

Michael Putman, MD, MSCI

Today I'm here to talk with you about steroids in lupus nephritis. The impetus for this is the 2024 ACR guideline for the management of lupus nephritis.

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Panacea of Prednisone & Cannabis (5.16.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal and regulatory reports from this week on RheumNow.com.  Interesting trends and results with prednisone in lupus, cannabis in RA and opioid deaths too!

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Lupus in an empty house

Eric Dein, MD

The full house immunofluorescence pattern is the classic histopathologic finding of lupus and lupus nephritis. Glomerular deposits staining for IgG, IgA, IgM, C3 and C1q can help confirm a suspected diagnosis of SLE. But what about patients with negative immunofluorescence and no proliferative or membranous features?

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Comparing EULAR (2025) and ACR (2020) Guidelines on Safety of Lupus Medications in Pregnancy

Catherine Sims, MD

Attendees at the 2025 RheumaPreg meeting were excited to discuss the newly released EULAR recommendations for use of antirheumatic drugs in reproduction, pregnancy, and lactation. Table 1 summarizes the major recommendations from EULAR (2025) and the American College of Rheumatology (2020) reproductive guidelines for commonly used medications in SLE. It should be noted that these two sets of guidelines largely align, however, the updated EULAR guidelines have included some additional medications incorporating data from the last five years.

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Vitamin D Headlines (5.9.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports and lupus highlights from the past week on RheumNow.com. Triple positivity, the gut and CRPS, and hope for better outcomes with Vitamin D therapy. 

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Treat to target 🎯 #SLE #recommendations Considerations are nuanced and Impt Lowest clinical disease activity is goal Try for remission 🎯 Get patients off #glucocorticoids If not ⬇️low dose #prednisone @RheumNow #LUPUS2025 https://t.co/HlBeh2FLxP

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Janet Pope Janetbirdope ( View Tweet)
controversy re 👇 Monitoring for +Ro pregnant re #congenital #heart #block 87% Y echo is possibly too late No ideas if flourinated #steroids work But many thing we should do something Guidelines differ on recommendations Would fetal home HR be better #LUPUS2025 @RheumNow https://t.co/MY0oPjLnGs

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Janet Pope Janetbirdope ( View Tweet)
‘It’s #Lupus, it’s all in your head!’ ➡️ Some patients with #SLE have heard this from others At #LUPUS2025 in a packed session on #CNS lupus #Dx is tricky 40% of #neuropsychiatric lupus have NEGATIVE #brain #MRI 👇r/o infarct/bleed Infection Rx #steroids @RheumNow https://t.co/yU1olg0uZU

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Janet Pope Janetbirdope ( View Tweet)
‘To screen or not’? For #CHB #congenital #heart #block Great debate #LUPUS2025 In #pregnant women with #SLE In + #Ro #SSA &/or #La #SSB mothers CHB Rx - #flourinated #steroids To ⬇️#fetal #mortality ❎no benefit ⬇️#cardiomyopathy ❎ ⬇️#pacemaker ❎ ⁦@RheumNow⁩ ??🤷‍♀️ https://t.co/xauDzfNBsC

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Janet Pope Janetbirdope ( View Tweet)
Vitiligo affects up to 2% of people globally; more in blacks & hispanics than whites & more common in women > men. The prevalence has increased over time. Oral corticosteroids are most frequently prescribed, followed by other immunosuppressive drugs https://t.co/wNh6z3lKg1 https://t.co/hQo9sNn4kg

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Dr. John Cush RheumNow ( View Tweet)
MTX works in pulmonary Sarcoid! NEJM reports Open label RCT of 138 un-Rx pulm. Sarcoid pts w/ either MTX or placebo. After 24 wks MTX was noninferior to PBO w/ mean change in FVC (-6.7 vs -6.1). AE: more Wt gain, insomnia w/ pred & more Nausea fatigue LFTs w/ MTX https://t.co/8XMCM2DitR
Dr. John Cush RheumNow ( View Tweet)
New Steroid Rules in Lupus? Let’s Talk. Dr. Michelle Petri breaks down the latest strategies to minimize steroid exposure while managing disease activity in lupus patients. 💡 Smarter steroid use = better outcomes. 👉 Watch now on RheumNow: https://t.co/vbjrXAlixz #Lupus https://t.co/TN5EkZhbef

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Dr. John Cush RheumNow ( View Tweet)
SLE trends: pulse methylprednisolone followed by low dose steroids is rec by various guidelines. Risk factors for SLE flare after GC withdrawal: high Dz activity, active serology, younger age, shorter remission duration, faster tapering strategy, shorter duration/cessation of https://t.co/g6LaTijOpA
Dr. John Cush RheumNow ( View Tweet)
#2 most downloaded paper in 2024 on Journal of Clinical Medicine was “IgA Vasculitis (Henoch–Schönlein Purpura): An Update on Treatment” - Steroids are 1st line Rx, esp in adults w/ severe IgAV; other Rx include calcineurin inhibitors, MMF, RTX , https://t.co/F5jogxkoGr

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Dr. John Cush RheumNow ( View Tweet)

Betw 2005 -2021, there was a substantial increase in HCQ use, but only modest steroid (GC) reductions. Swedish cohort study of 3891 SLE pts - over 5 yrs GC decr from 68% - 54% to 46%. HCQ increased by 29% over 5 years. https://t.co/6LZVMt9zy7 https://t.co/WunjnBBTW9

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Dr. John Cush RheumNow ( View Tweet)
Betw 2005 -2021, there was a substantial increase in HCQ use, but only modest steroid (GC) reductions. Swedish cohort study of 3891 SLE pts - over 5 yrs GC decr from 68% - 54% to 46%. HCQ increased by 29% over 5 years. https://t.co/sI7JWq3AGk https://t.co/RBUMcl8uGz

Links:

Dr. John Cush RheumNow ( View Tweet)
New Steroid Rules in Lupus? Let’s Talk. Dr. Michelle Petri breaks down the latest strategies to minimize steroid exposure while managing disease activity in lupus patients. 💡 Smarter steroid use = better outcomes. 👉 Watch now on RheumNow: https://t.co/vbjrXAlixz #Lupus https://t.co/04CjTkCqMJ

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Dr. John Cush RheumNow ( View Tweet)
Stable SLE - Should you Withdraw Immunosuppressant or Glucocorticoids? An open-label, single-centre, randomized controlled trial tested whether immunosuppressant (IS) withdrawal is noninferior to glucocorticoid (GC) withdrawal in SLE patients and found that IS withdrawal is https://t.co/T8Fu83GScH
Dr. John Cush RheumNow ( View Tweet)
Glucocorticoids in SLE: how to start, how to follow, how to stop More than 70 years after their first use in rheumatology by Philip Hench, glucocorticoids (GCs) continue to be one of the main weapons to fight systemic lupus erythematosus (SLE). No other available medication https://t.co/H6N0N3BhhU
Dr. John Cush RheumNow ( View Tweet)
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