Table 1 Treatment recommendation for juvenile SLE

1. Hydroxychloroquine

◦ 5 mg/kg/day

2. Glucocorticoid

• at the lowest dosage

◦ initially 1–2 mg/kg/day or in case of severe disease: intravenous pulse therapy 30 mg/kg/dose three consecutive days

◦ 10%–20% at 1-week or 2-week interval based on clinical improvement

3. Methotrexate

• skin and joint involvement

4. Azathioprine/mycophenolate mofetil

• Class II, III, IV, V lupus nephritis

5. Tacrolimus, ciclosporine

• Pure class V lupus nephritis in selected case (nephrotoxicity)

Then, in addition of DMARDs

6. Belimumab

• Class III, IV lupus nephritis

• skin and joint involvement

◦ 10 mg/kg/month

7. Rituximab

• Refractory lupus nephritis

◦ 4 × 375 mg/m²/week

◦ 2 × 750 mg/m²/14 days

8. Cyclophosphamide

• class III/IV or refractory lupus nephritis

• Severe neurolupus

◦ 6 × 500 mg or 500 mg/1,73 m² every 2 weeks for three months EURO-LUPUS

◦ 0,75–1 g/m² monthly for 6–9 months NIH lupus regimen