Patient handout

SLE flare (acute)

PRODUCTION

1. Your condition

This handout is for sle flare (acute). Your care team identified this based on: new / worsening malar rash, photosensitive flare.

Other reasons your team may use this plan: inflammatory polyarthritis / pleuritic pain; rising anti-dsdna / falling c3-c4; new proteinuria upcr > 0.5 (lupus nephritis).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
hydroxychloroquine	5 mg/kg actual weight (typically 200-400 mg/d)	PO	daily	2023 EULAR strong — universal for all SLE; reduces flares + thrombosis + mortality
prednisone_low_dose	5-15 mg PO daily short course	PO	daily, taper over 2-4 weeks	Short course; minimise cumulative dose (EULAR 2023 Fanouriakis)
topical_corticosteroid	Per location (mid-potency for face, high-potency for trunk/extremities)	topical	BID x 2-4 weeks	First-line topical for cutaneous lupus (EULAR 2023)

Plan: SLE flare — mild / moderate / severe (2023 EULAR + 2024 ACR/EULAR LN)

3. When to call your provider

Contact your care team if any of the following happen:

New proteinuria > 0.5 g/g, active sediment then urgent renal biopsy (ACR 2024 lupus nephritis)
New seizure, psychosis, focal deficit then ED for NPSLE workup (EULAR 2023)
Alveolar hemorrhage / hypoxia then ED + ICU (EULAR 2023)
Refractory thrombocytopenia (<30K) then admit (BSR 2018)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

New proteinuria >0.5 g/g + active urine sediment + AKI
Hypoxia + hemoptysis + diffuse pulmonary infiltrates + falling Hb(life-threatening)
Psychosis, seizure, myelitis, cerebritis, coma in SLE patient(life-threatening)
Multiple thrombotic events in <1 week with multi-organ failure(life-threatening)
Platelets <30K with bleeding or refractory to first-line
Schistocytes + low platelets + AKI in SLE patient(life-threatening)
Fever + multi-organ symptoms + ELEVATED CRP (rare in pure SLE flare)

5. Follow-up

Lifelong rheumatology continuity; SLE-PASS / SLEDAI-2K trend; minimise glucocorticoids; vaccinations (zoster, pneumococcal, HPV, COVID, influenza); CV risk modification; pregnancy planning when stable ≥6 months

6. Sources

Guideline: 2023 EULAR Recommendations for SLE (Fanouriakis et al, ARD 2024) + 2024 ACR/EULAR Lupus Nephritis + AURORA / AURORA-2 (voclosporin) + TULIP (anifrolumab) + BLISS-LN (belimumab)