Since most SLE flares are mild to moderate, she suggested treating them with a burst of steroids, with either a medrol dose pack or triamcinolone 100-mg intramuscular, rather than with maintenance prednisone, similar to how neurologists treat multiple-sclerosis flares with steroids and then nothing.
Dr. Petri described the results of a clinical trial showing that patients experienced substantial improvement by days one and two after starting the therapy. By one month, the patients did not require rescue therapy. “Now if they had, we would have known they needed to start an immunosuppressant drug. If someone breaks through a burst of steroids, they’re telling you it’s not just a flare, they’re having some constant activity that needs to be suppressed,” she said, noting that triamcinolone injections should not be given more often than every three months.
Stephanie Cajigal is a medical journalist based in California.