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Successful treatment of combined proliferative and membranous lupus nephritis using a full corticosteroid-free regimen
  1. Bruno Tedeschi1,2,
  2. Laurent Arnaud1,3,
  3. Miguel Hie1,3,
  4. Alexis Mathian1,3,
  5. Zahir Amoura1,3
  1. 1Department of Internal Medicine, French reference centre for Systemic Lupus Erythematosus, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
  2. 2Hospital Universitário Clementino Fraga Filho (HUCFF), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
  3. 3Université Pierre et Marie Curie, UPMC Univ Paris 06, Paris, France
  1. Correspondence to Dr Laurent Arnaud, Service de Médecine Interne 2, Groupe Hospitalier Pitié-Salpêtrière, 47–83 bd de l'Hôpital, Paris 75013, France; Laurent.arnaud{at}psl.aphp.fr

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Dear Sir,

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 …

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