Division of Rheumatology, University of Padova, Padua, Italy.
Division of Rheumatology, University of Padova, Padua, Italy.
Autoimmun Rev. 2014 Jul;13(7):770-7. doi: 10.1016/j.autrev.2014.01.055. Epub 2014 Jan 27.
Patients affected with systemic lupus erythematosus (SLE) display poor-long term prognosis and increased mortality in respect of general population. This may be due to continuous organ damage accrual which is fostered both by persistent disease activity (mainly in the short term) and prolonged corticosteroid exposure (mainly in the long term). The effort of defining novel therapeutic goals to which patients should be treated in order to have their prognosis improved is named treat-to-target. Remission in SLE was shown to be associated with better outcome and prolonged survival; in clinical practice, patients may experience either complete or clinical remission, which are defined as complete clinical/serological healing or no clinical signs of lupus with active serology, respectively. The main treat-to-target in SLE is complete remission, however since longitudinal observations suggest that clinical remission or low disease activity even with minimal corticosteroid intake do improve patients prognosis and survival as well, they may be assumed as acceptable alternative targets. Suitable therapeutic strategies have to be defined in order for these goals to be achieved including early diagnosis, effective treatment and proper corticosteroid tapering which in turn require development of more reliable serum biomarkers for early disease detection and less toxic targeted therapies with a steroid-sparing potential.
患有系统性红斑狼疮 (SLE) 的患者在总体人群中的预后较差且死亡率较高。这可能是由于持续的器官损伤累积造成的，这种损伤既由持续的疾病活动（主要在短期内）又由长期的皮质类固醇暴露（主要在长期内）促进。定义新的治疗目标的努力是为了改善患者的预后，这一目标被称为治疗目标。SLE 的缓解与更好的结果和延长的生存有关；在临床实践中，患者可能经历完全缓解或临床缓解，这分别定义为完全临床/血清学治愈或有活跃的血清学但无狼疮的临床体征。SLE 的主要治疗目标是完全缓解，然而，由于纵向观察表明临床缓解或低疾病活动，甚至在最小剂量的皮质类固醇摄入下，也可以改善患者的预后和生存，因此这些缓解也可以被认为是可接受的替代目标。为了实现这些目标，必须定义合适的治疗策略，包括早期诊断、有效治疗和适当的皮质类固醇减量，这反过来又需要开发更可靠的血清生物标志物以早期发现疾病和具有类固醇节约潜力的毒性更小的靶向治疗。
