Asymptomatic serologic reactivation in patients with lupus nephritis in clinical remission: to treat or not to treat?

Lupus nephritis flares are occasionally preceded by a rise in serologic activity. To date, watchful waiting is the suggested approach for patients with such a serologic reactivation. Yap et al. performed a randomized trial testing a pre-emptive increase in immunosuppression versus watchful monitoring in patients with stable lupus nephritis who had a rise in their anti-double-stranded DNA antibodies. We discuss their results in the context of the current landscape and expanding therapeutic options for the management of lupus nephritis.