Final answer:
For a 27-year-old pregnant patient with a flare of systemic lupus erythematosus (SLE), steroids are the most suitable initial treatment to manage inflammation and symptoms such as malaise, joint aches, and fever.
Step-by-step explanation:
The 27-year-old G1P0 patient at 22 weeks gestation with systemic lupus erythematosus (SLE) who is presenting with malaise, joint aches, and fever, and has elevated blood pressure with proteinuria, requires careful management that takes into account both her pregnancy and her autoimmune condition. In this case, the most appropriate initial therapy would be steroids. SLE is an autoimmune disease characterized by autoantibodies, such as anti-nuclear antibodies (ANAs), leading to widespread inflammation and tissue damage.
Corticosteroids are effective in managing the inflammation associated with SLE and would address the presenting symptoms of malaise, joint aches, and fever. Azathioprine and cyclophosphamide are immunosuppressive drugs used in SLE, but they are typically reserved for more severe disease and not first-line for moderate flare in pregnancy.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally avoided due to the risk of adverse effects on the fetus. Magnesium sulfate is used for seizure prophylaxis in preeclampsia and not for SLE. Therefore, considering the urgency of symptom management and the patient's pregnancy, steroids are the most appropriate initial treatment.