González Luis Alonso, Alarcón Graciela S
a Division of Rheumatology, Department of Internal Medicine, School of Medicine , Universidad de Antioquia , Medellín , Colombia.
b Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine , The University of Alabama at Birmingham , Birmingham , AL , USA.
Expert Rev Clin Immunol. 2017 Aug;13(8):753-768. doi: 10.1080/1744666X.2017.1327353. Epub 2017 May 22.
The survival of SLE patients has improved significantly over the past few decades placing them at increased risk of cardiovascular disease (CVD), malignancies, and osteoporosis, among other comorbidities. The aim of this review was to assess the incidence and prevalence of comorbidities in these patients as well as their prevention and treatment focusing in CVD, malignancies and osteoporosis. Areas covered: We focused on CVD, malignancies and osteoporosis as SLE comorbidities. A literature search (PubMed database) was performed using the words 'comorbidities', 'cardiovascular disease', 'osteoporosis', 'malignancy', 'cancer' and 'lupus' between January 1976 and December 2016. No language restrictions were placed. More than 100 full-length articles were reviewed. Expert commentary: The therapeutic approach in SLE should aim not only at achieving disease remission but also at treating all conditions affecting the patients and, consequently, their outcomes. These patients should be treated as coronary artery disease (CAD) equivalent with rigorous modifiable CV risk factors management in addition to the optimal treatment of their lupus. Furthermore, modifiable osteoporosis traditional risk factors and SLE-related risk factors should be modified to ameliorate bone loss and fracture risk. Cancer preventive measures (smoking cessation and screening programs for cervical cancer) constitute also essential components of the management of these patients.
在过去几十年里，系统性红斑狼疮（SLE）患者的生存率有了显著提高，但这也使他们患心血管疾病（CVD）、恶性肿瘤和骨质疏松症等其他合并症的风险增加。本综述的目的是评估这些患者合并症的发病率和患病率，以及针对CVD、恶性肿瘤和骨质疏松症的预防和治疗。涵盖领域：我们重点关注CVD、恶性肿瘤和骨质疏松症这几种SLE合并症。在1976年1月至2016年12月期间，使用“合并症”“心血管疾病”“骨质疏松症”“恶性肿瘤”“癌症”和“狼疮”等关键词在PubMed数据库中进行了文献检索。未设语言限制。共查阅了100多篇全文文章。专家评论：SLE的治疗方法不仅应旨在实现疾病缓解，还应治疗影响患者的所有病症，从而改善其预后。除了对狼疮进行最佳治疗外，这些患者应被视为等同于冠状动脉疾病（CAD），对可改变的心血管危险因素进行严格管理。此外，应改变可改变的骨质疏松传统危险因素和与SLE相关的危险因素，以减轻骨质流失和骨折风险。癌症预防措施（戒烟和宫颈癌筛查项目）也是这些患者管理的重要组成部分。
