Rheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate, 10, B-1200 Bruxelles, Belgium.
Arthritis Res Ther. 2012 Jan 31;14(1):202. doi: 10.1186/ar3656.
Despite numerous randomized clinical trials over the last three decades for identifying the optimal treatment option for lupus nephritis, renal involvement still significantly impacts the survival and quality of life of patients with lupus and the search for the ideal immunosuppressive regimen is far from complete. The purpose of this review is to summarize the major recent achievements in the field. More specifically, the following topics will be discussed: intravenous cyclophosphamide versus mycophenolate mofetil (MMF) for induction; azathioprine versus MMF for maintenance; targeted therapies. The review will address clues for optimal global care, such as the need for complete initial evaluation, the importance of patient education, the unmasking of non-compliance to therapy, the reason for an early treatment switch in non-responding patients, the need for prolonged immunosuppression, optimal renal protection, and prevention of cardiovascular disease and other comorbidities.
尽管在过去的三十年中进行了大量的随机临床试验，以确定狼疮肾炎的最佳治疗选择，但肾脏受累仍然严重影响狼疮患者的生存和生活质量，寻找理想的免疫抑制方案仍远未完成。本文的目的是总结该领域的主要最新进展。更具体地说，将讨论以下主题：诱导治疗时静脉注射环磷酰胺与霉酚酸酯（MMF）的比较；硫唑嘌呤与 MMF 用于维持治疗；靶向治疗。本文将探讨实现最佳整体治疗的线索，例如需要进行全面的初始评估、重视患者教育、发现治疗不依从性、对无应答患者进行早期治疗转换的原因、需要延长免疫抑制治疗、最佳肾脏保护以及预防心血管疾病和其他合并症。
