Departamento de Medicina Interna, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina.
Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.
Ann Rheum Dis. 2018 Nov;77(11):1549-1557. doi: 10.1136/annrheumdis-2018-213512. Epub 2018 Jul 25.
Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.
系统性红斑狼疮（SLE）是一种复杂且异质性的自身免疫性疾病，在诊断和治疗方面均极具挑战性。拉丁美洲的 SLE 患者面临着一些特殊问题，在制定治疗指南时应予以考虑。本研究旨在为拉丁美洲狼疮患者制定临床实践指南。两个独立的团队（有狼疮管理经验的风湿病学家和方法学家）于 2016 年 4 月在巴拿马城举行了首次会议。他们选择了一系列在拉丁美洲 SLE 患者中最常见的临床问题的清单。这些问题根据最佳现有证据进行了评估，并按照推荐评估、制定和评估方法的标准格式进行了总结。所有初步发现均在 2016 年 11 月于华盛顿特区举行的第二次面对面会议上进行了讨论。结果，提出了九个器官/系统部分的主要发现；并添加了一个“全面”的治疗方法。特别强调了区域实施问题。对肌肉骨骼、黏膜皮肤、肾脏、心脏、肺部、神经精神、血液系统表现和抗磷脂综合征的最佳药物治疗选择进行了检查。在每个部分中，均总结了主要治疗选择（即糖皮质激素、抗疟药、免疫抑制剂、治疗性血浆置换、贝利尤单抗、利妥昔单抗、阿巴西普、低剂量阿司匹林和抗凝剂）的作用。在所有情况下，均考虑了获益与危害、证据确定性、价值观和偏好、可行性、可接受性和公平性问题，以提出特别关注种族和社会经济方面的建议。已经为拉丁美洲狼疮患者制定了指南，并可在类似环境中使用。
