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Thirty to seventy per cent of patients with systemic lupus erythematosus (SLE) eventually develop lupus nephritis (LN), with increased risk for renal failure and cardiovascular events, conferring reduced survival. Current recommendations for first-line treatment of proliferative LN involve an induction therapy using a combination of high-dose intravenous steroids followed by oral steroids and either cyclophosphamide (CYC) or mycophenolate mofetil (MMF), then a maintenance phase with oral corticosteroids and either MMF or azathioprine.1 LN mandates long-term treatment and therefore exposes patients to corticosteroids adverse events. Recently, an observational study using no oral steroids has shown promising preliminary results.2 Therefore, the use of an alternative full steroid-free treatment regimen would be a major advance in LN.
In 2001, a 37-year-old man was diagnosed with SLE based on the presence of arthritis, leucopenia, antinuclear antibodies (1:320) with positive search for anti-dsDNA and anti-Sm antibodies. He had a past medical history of gout and was treated with allopurinol. In 2003, treatment with hydroxychloroquine and intermittent oral prednisone (no more than 10 mg/day) was started for polyarthritis. In 2008, without any sign of active lupus, he …