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© 1989 British Society for Rheumatology

other

CLINICAL CONUNDRUM

G. R. V. HUGHES

Lupus Arthritis Research Unit, The Rayne Institute, St. Thomas' Hospital London SE1 7EH, UK

A 47-year-old woman presented with a 20-year history of SLE with predominant symptoms of arthritis controlled on 5 mg prednisolone/day. Attempts to reduce her steroids further have failed and chloroquine and NSAIDs In the past have been insufficient to control the disease activity. Systemic features have been absent in the test 10 years though previously she has had pleuritis, pericarditis, alopecia and a malar rash. (The ANA is 1:256 with normal DNA binding, ESR is currently 22 mm/h.) Her bone mass is at the lower limit of normal determined by dual pboton-absorptlometry.

As she is now menopausal should she have HRT to prevent osteoporotic complications or would this lead to worsening of her SLE?.


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