Management for serositis in SLE

Note: Acute severe serositis associated with SLE requires specialist management.

Acute severe serositis associated with SLE requires specialist management; patients with pericardial or pleural effusion, or peritonitis usually respond rapidly to pulse intravenous methylprednisolone. The usual dosage for acute severe serositis in SLE in adults is:

methylprednisolone sodium succinate 0.5 to 1 g intravenously, over 1 hour, daily for 3 days, then switch to oral prednisolone (or prednisone) as below. methylprednisolone sodium succinate methylprednisolone methylprednisolone

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

prednisolone (or prednisone) 25 to 60 mg orally, daily. prednis ol one prednis(ol)one prednis(ol)one

When high-dose systemic corticosteroids are used, their adverse effects may complicate assessment of disease activity (eg high-dose systemic corticosteroids can induce hypomania). For additional considerations specific to systemic corticosteroid use, see Specific considerations for use of systemic corticosteroids.

In mild serositis, nonsteroidal anti-inflammatory drugs (NSAIDs) may be sufficient to control pain. All of the NSAIDs listed below are equally effective, and drug choice should be based on patient factors (eg comorbidities); see Choosing an NSAID for advice on drug choice. If an NSAID is indicated for pain and inflammation associated with mild serositis in SLE, in adults use:

1celecoxib 100 to 200 mg orally, daily in 1 or 2 divided doses, until symptoms subside celecoxib celecoxib celecoxib

OR

1etoricoxib 30 to 60 mg orally, daily until symptoms subside etoricoxib etoricoxib etoricoxib

OR

1ibuprofen immediate-release 200 to 400 mg orally, 3 or 4 times daily until symptoms subside ibuprofen ibuprofen ibuprofen

OR

1indometacin 25 to 50 mg orally, 2 to 4 times daily until symptoms subside indometacin indometacin indometacin

OR

1ketoprofen modified-release 200 mg orally, daily until symptoms subside ketoprofen ketoprofen ketoprofen

OR

1meloxicam 7.5 to 15 mg orally, daily until symptoms subside meloxicam meloxicam meloxicam

OR

1naproxen immediate-release 250 to 500 mg orally, twice daily until symptoms subside naproxen naproxen naproxen

OR

1naproxen modified-release 750 to 1000 mg orally, daily until symptoms subside naproxen naproxen naproxen

OR

1piroxicam 10 to 20 mg orally, daily until symptoms subside piroxicam piroxicam piroxicam

OR

2diclofenac 25 to 50 mg orally, 2 or 3 times daily until symptoms subside. diclofenac diclofenac diclofenac

The potential benefits of an NSAID should be weighed against its potential harms, particularly in patients at high risk of harms (see Principles of NSAID use for more information).

Hydroxychloroquine may be used to reduce the frequency of flares of serositis in SLE. Persistent or recurrent serositis may require the addition of systemic corticosteroids or methotrexate under specialist supervision.