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Carrie is a 35-year-old woman with a 4-year history of systemic lupus erythematosus (SLE). She is currently taking hydroxychloroquine
and low dose glucocorticoids to manage her lupus. During today's follow up visit, Carrie reports that she continues to have
persistent pain in her hands and wrists. She frequently feels tired, and has had to reduce many of her daily activities and
travel to rest. Overall, she feels that her lupus is interfering more with her daily life. On physical exam, the clinician
notes malar rash on her face. Her labs today show elevated anti-dsDNA antibody levels, and low complement (C) 3 and C4 levels.