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2015 ; 112
(25
): 423-32
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The Diagnosis and Treatment of Systemic Lupus Erythematosus
#MMPMID26179016
Kuhn A
; Bonsmann G
; Anders HJ
; Herzer P
; Tenbrock K
; Schneider M
Dtsch Arztebl Int
2015[Jun]; 112
(25
): 423-32
PMID26179016
show ga
BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease with a
prevalence of 36.7/100 000 in Germany and a female/male ratio of 4:1. The
clinical course is variable, with a broad spectrum of organ manifestations; lupus
nephritis develops in about half of all patients. METHODS: This review is based
on a selective search of PubMed and the Cochrane Library, including current
guidelines and expert recommendations. RESULTS: Assessment of clinical symptoms,
laboratory findings, and optional biopsy results are the basis for early
diagnosis of SLE. All patients should be treated with antimalarials as soon as
the diagnosis is confirmed. In particular, hydroxychloroquine is associated with
a higher rate of remission, fewer relapses, and reduced damage in the course of
the disease, even in lupus nephritis. High-dose glucocorticoids should be given
only when acutely indicated; immunosuppressives such as azathioprine,
methotrexate, or mycophenolate mofetil may be administered to reduce
glucocorticoids, according to the EULAR recommendations. Belimumab was recently
approved as add-on therapy in autoantibody-positive SLE patients with high
disease activity unresponsive to standard treatment. Short-term induction pulse
therapy with low-dose intravenous cyclophosphamide, as well as continued
mycophenolate mofetil treatment are advances in lupus nephritis. CONCLUSION: The
long-term prognosis for SLE has improved markedly in recent decades because of
earlier diagnosis and optimized treatment. Further research and randomized
controlled trials are needed for the development of specifically targeted
therapies.
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