Apostolopoulos Diane, Morand Eric F
School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia.
Rheumatology (Oxford). 2017 Apr 1;56(suppl_1):i114-i122. doi: 10.1093/rheumatology/kew406.
The treatment of SLE remains complex, and management is constrained by a lack of safe, effective, targeted therapies. Physicians, also, are constrained by a lack of evidence-based approaches with existing agents, including glucocorticoids, utilized in the majority of patients. While Cushingoid side effects of glucocorticoids are widely recognized, emerging literature now suggests that glucocorticoid use actually contributes to harmful outcomes in SLE, over and above these effects. These studies provide a compelling case for a re-evaluation of the long-term use of glucocorticoids in SLE, focusing on minimizing glucocorticoid exposure as part of the strategy to improve long-term outcomes. In this article, we review the evidence for the harmful effects of glucocorticoids in SLE, and propose therapeutic options that reduce reliance on glucocorticoids. We propose that it is time for the lupus community to have a louder conversation about glucocorticoid use, and for any residual complacency about their risk-benefit ratio to be banished.
系统性红斑狼疮（SLE）的治疗仍然很复杂，由于缺乏安全、有效、有针对性的治疗方法，其管理受到限制。此外，医生也受到限制，因为在大多数患者中使用包括糖皮质激素在内的现有药物缺乏循证医学方法。虽然糖皮质激素的库欣样副作用已广为人知，但新出现的文献表明，糖皮质激素的使用实际上在这些影响之外，还会导致SLE患者出现有害后果。这些研究为重新评估糖皮质激素在SLE中的长期使用提供了令人信服的理由，将尽量减少糖皮质激素暴露作为改善长期预后策略的一部分。在本文中，我们回顾了糖皮质激素在SLE中产生有害影响的证据，并提出了减少对糖皮质激素依赖的治疗选择。我们认为，狼疮界是时候更深入地讨论糖皮质激素的使用了，并且要消除对其风险效益比的任何残余自满情绪。
