What is the preferred initial treatment for lupus arthritis?

What is the preferred initial treatment for lupus arthritis?

• A. Hydroxychloroquine
• B. Methotrexate
• C. NSAIDs
• D. Corticosteroids

Answer: (A)

Starting hydroxychloroquine addresses the autoimmune process underlying lupus arthritis and is favored as the initial management because it can modify the disease course, reduce flares, and improve long-term outcomes with a relatively favorable safety profile. NSAIDs can help with joint pain, but they don’t alter the underlying disease and don’t prevent progression. Corticosteroids control inflammation quickly but have significant long-term side effects, making them less ideal as a first-line approach. Methotrexate may be added if arthritis remains active despite antimalarial therapy or to spare steroids, but it’s not the preferred first choice due to different risk profiles and less consistent disease-modifying benefit in lupus arthritis. Hydroxychloroquine, by contrast, provides disease-modifying benefits in lupus, improves overall disease activity, and is appropriate even for mild arthritis. Monitor for retinal toxicity with regular eye exams and adjust dosing appropriately.

Starting hydroxychloroquine addresses the autoimmune process underlying lupus arthritis and is favored as the initial management because it can modify the disease course, reduce flares, and improve long-term outcomes with a relatively favorable safety profile.

NSAIDs can help with joint pain, but they don’t alter the underlying disease and don’t prevent progression. Corticosteroids control inflammation quickly but have significant long-term side effects, making them less ideal as a first-line approach. Methotrexate may be added if arthritis remains active despite antimalarial therapy or to spare steroids, but it’s not the preferred first choice due to different risk profiles and less consistent disease-modifying benefit in lupus arthritis. Hydroxychloroquine, by contrast, provides disease-modifying benefits in lupus, improves overall disease activity, and is appropriate even for mild arthritis.

Monitor for retinal toxicity with regular eye exams and adjust dosing appropriately.