ACTUALITY: Systemic Lupus Erythematous is a chronic inflammatory condition caused by an autoimmune process. That affects the skin, heart, joint, kidney and other organs.

Several recent studies have suggested that the incidence of systemic lupus erythematosus is increasing with coincidental increase in survival rate of between 51-63% Systemic lupus erythematosus is known to be more prevalent in females than in males with a ratio of 4:2.

AIM:To study a Case of a 40 year old woman with systemic lupus erythematosus with the use of immunosuppressive drugs with progressive disease activity (lupus nephritis) before the usage of Mycophenolate mofetil according to SLEDAI-2k score.

METHOD AND MATERIALS: Case history and discharges of the patient.

A 40years old female. Patient was first diagnosed with SLE at age 13. Her disease has had skin involvement manifesting a butterfly rash also polyarthritis, tenosynovitis, joint subluxations n8, pneumonitis, pleurisy, vasculitis as well as lupus nephritis. Anamnesis: She was first treated with corticosteroids from 1991 then later put on Hydroxychloroquine and Azathioprine until 2013. In 2013, she had pleurisy treated with pulse corticosteroid (methylprednisolone) therapy. In 2014, she was started on treatment with different doses of prednisolone ranging from a dose of 30 mg to about 16 mg methylprednisolone per day during exacerbations. She was also giving pulse corticosteroid therapy sometimes with 500 mg IV methylprednisolone. In 2015, she exhibited symptoms of proteinuria which was treated with 500mg of Methylprednisolone IV for 3 days/month and Cyclophosphamide 1000 mg IV monthly. This treatment was not effective in controlling her symptoms and a kidney biopsy was done. The biopsy confirmed a diagnosis of lupus nephritis class 4. Serological tests were also performed. Cyclophosphamide was stopped due to risk of infertility, Belimumab and Mycophenolate mofetil were other options for treatment but these were too expensive so she was put on Azathioprine. This treatment was also not very effective in controlling her symptoms. In 2017, she was able to afford Mycophenolate mofetil and was put on this drug for a while. This lasted for that year until she was put on a maintenance regimen of Hydroxychloroquine in 2018. DIAGNOSIS: SLE chronic course 2nd stage of activity with involving of skin - butterfly rash with Lupus-Arthritis, tenosynovitis complicated by subluxation of the joint of 1st and 5th finger, lupus-nephritis (Class 4 according to biopsy in 2015).DYNAMICS OF TREATMENT:1991-2013: usage of corticosteroid hydrochloroquine, severe disease activity and azathioprine to control SLE flare. In this period patient developed pleurisy, 2014: treated with different doses of prednisolone range from 7.5mg to 16mg/day + pulse corticosteroid 500mg. (Methylprednisolone). 2015: Due to development of Lupus Nephritis. 500mg of methylprednisolone IV for 3 days + 1000 mg cyclophosphamide IV/ month for 3 months was prescribed. 2016: Belimumab and mycophenolate mofetil were the next drugs of choice but patient was unable to afford them, then patient was asked to take azathioprine. 2017: patient started the usage of Mycophenolate mofetil. 2018: Disease remission was achieved and she was placed on a maintenance regimen of hydroxychloroquine.

CONCLUSION:

With adequate control of disease progression, disease remission was attained.