Systemic corticosteroids for SLE in adults

Systemic corticosteroids are commonly used, in addition to hydroxychloroquine, for severe organ- or life-threatening features of SLE (eg SLE-associated vasculitis, lupus nephritis), but they are usually not required for mild disease. Depending on the features of SLE present, patients may be started on pulse intravenous or high-dose oral corticosteroids. The duration of systemic corticosteroid therapy is determined by specialists and tapering is complex.

Patients with severe features of SLE may require initial treatment with pulse intravenous methylprednisolone; the usual dosage for adults is:

If high-dose oral corticosteroids are indicated for severe features of SLE, either initially or following pulse intravenous methylprednisolone, the usual dosage for adults is:

When high-dose systemic corticosteroids are used, their adverse effects may complicate assessment of disease activity (eg high-dose systemic corticosteroids can induce hypomania).

If oral corticosteroids are indicated for mild features of SLE (eg rash, arthralgia), much lower dosage is recommended; for adults, use:

If chronic oral corticosteroids are required to maintain disease control, minimise the prednisolone (or prednisone) dose to less than 7.5 mg/dayFanouriakis, 2021. Often other immunomodulatory drugs are started early in the treatment of SLE for their corticosteroid-sparing effect and to achieve control of disease activity.

Systemic corticosteroid dosing for children and adolescents is complex and must be managed by a specialist; see Systemic corticosteroids for SLE in children and adolescents.