{
  "abstract": "Objectives Background Systemic lupus erythematosus (SLE) is a chronic, heterogeneous autoimmune disease requiring individualized, multidimensional management. Even in the biologic era, therapeutic gaps persist in patients with longstanding disease, drug intolerance, or corticosteroid contraindications.Aim To present a real-life, difficult-to-treat case of SLE with sustained serological remission but persistent clinical activity and limited therapeutic alternativesMethods We retrospectively analyzed the patient’s clinical course, disease activity (SLEDAI), patient-reported outcomes (HAQ-DI), immunological markers (ANA, anti-dsDNA, complement), and treatment regimens from diagnosis to present.Results A 49-year-old woman was diagnosed with SLE over 20 years ago (baseline SLEDAI = 10) with cutaneous, articular, and serological involvement (ANA 1:1280, anti-dsDNA positive, low C3/C4). Initial therapy with hydroxychloroquine (200 mg/day) and low-dose prednisone (7.5 mg/day) achieved clinical remission (SLEDAI < 4) for nearly a decade. Azathioprine (2 mg/kg/day) was added but discontinued due to intolerance (nausea, cytopenia).Four years ago, disease reactivation occurred with symmetrical non-erosive arthritis (SLEDAI = 8), while serological markers normalized (dsDNA negative, complement restored). Corticosteroid-induced dermatitis contraindicated further glucocorticoid use. Methotrexate (20 mg/week) and hydroxychloroquine were maintained, yet arthritis persisted with HAQ-DI = 1.25 and morning stiffness > 60 min. Repeated musculoskeletal ultrasound confirmed synovial thickening and Doppler activity (grade 2). The patient remains in clinical flare without immunological activity and does not meet current eligibility criteria for biologic therapy (belimumab, anifrolumab).Conclusions This case exemplifies the clinical–serological dissociation and therapeutic limitations seen in difficult-to-treat SLE. Despite low serologic activity, persistent articular inflammation and functional impairment highlight the unmet need for expanded biologic eligibility criteria and novel strategies targeting musculoskeletal residual disease to achieve true remission in SLE.",
  "authors": [
    {
      "affiliations": [
        "Faculty of Medicine and Medical Sciences, USV, Suceava, Romania"
      ],
      "name": "Iulia Codruta Bran"
    },
    {
      "affiliations": [
        "Medical Practice, Iasi, Romania"
      ],
      "name": "Eugen Gigel Ancuta"
    },
    {
      "affiliations": [
        "Sanocare, Iasi, Romania"
      ],
      "name": "Rodica Chirieac"
    },
    {
      "affiliations": [
        "Gr. T. Popa University of Medicine, Iasi, Romania",
        "Clinical Rehabilitation Hospital, Iasi, Romania"
      ],
      "name": "Codrina Mihaela Ancuta"
    }
  ],
  "title": "PO:10:270 Real life, beyond criteria",
  "uid": "2af4ba7b-f4da-5e19-ba76-44fe0b68e7ba"
}