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Sorry to hear this. Lupus is a pretty complex disease, and I do hope all avenues and possibilities have been considered. I can't say by any means that dietary changes, or even something more drastic such as a mucrobiome 'transplant' would help but perhaps it's worth inquiring about. Even a small improvement would be amazing!I'm not certain. As grand parents our input is somewhat limited. Her primary care specialist is a department head in one of the Baltimore hospitals so I hope this has been considered. Her medical condition coupled with the fact that she is an adopted Asian child in a Caucasian family is making life tough for her. The fact that her sister is 'near genius' level just adds to the mess. I can't help, and it tears me up.