Guillevin Loïc, Pagnoux Christian
Service de Médecine Interne, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Paris-Nord, Bobigny, France.
Intern Med. 2003 Apr;42(4):313-7. doi: 10.2169/internalmedicine.42.313.
Steroids and immunosuppressants are indicated to treat systemic vasculitides. However, the therapeutic strategy is different from one disease to the other. Treatment choice should be adapted to the predictable outcome, severity, pathogenic mechanisms and patient's general condition. In polyarteritis nodosa, Churg Strauss syndrome, and microscopic polyangiitis we have demonstrated that immunosuppressants should not be systematically prescribed. Immunosuppressants should be only prescribed in the most severe patients, when factors of poor prognosis are present. In Wegener's granulomatosis, immunosuppressants should be systematically prescribed together with steroids. The optimal treatment duration is of 12 months for polyarteritis nodosa and Churg-Strauss syndrome. A more prolonged treatment is mandatory in Wegener's granulomatosis, at least 18 months. The new therapeutic strategies comprise also new immunosuppressants and new immunomodulating agents which could replace or be associated to the "older drugs".
类固醇和免疫抑制剂可用于治疗系统性血管炎。然而，不同疾病的治疗策略有所不同。治疗选择应根据可预测的结果、严重程度、致病机制和患者的一般状况进行调整。在结节性多动脉炎、变应性肉芽肿性血管炎和显微镜下多血管炎中，我们已经证明不应常规使用免疫抑制剂。只有在存在预后不良因素的最严重患者中才应使用免疫抑制剂。在韦格纳肉芽肿中，免疫抑制剂应与类固醇一起常规使用。结节性多动脉炎和变应性肉芽肿性血管炎的最佳治疗持续时间为12个月。韦格纳肉芽肿需要更长时间的治疗，至少18个月。新的治疗策略还包括新的免疫抑制剂和新的免疫调节剂，它们可以替代“老药”或与“老药”联合使用。
