Department of Medicine and Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany; German Rheumatism Research Center (DRFZ), Berlin, Germany.
Division of Rheumatology Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA.
Lancet. 2019 Jun 8;393(10188):2344-2358. doi: 10.1016/S0140-6736(19)30546-X. Epub 2019 Jun 6.
The heterogeneity of systemic lupus erythematosus (SLE), long recognised by clinicians, is now challenging the entire lupus community, from geneticists to clinical investigators. Although the outlook for patients with SLE has greatly improved, many unmet needs remain, chief of which is the development of safer and more efficacious therapies. To develop innovative therapies, a far better understanding of SLE pathogenesis as it relates to the array of clinical phenotypes is needed. Additionally, to efficiently achieve these goals, the lupus community needs to refine existing clinical research tools and better adapt them to overcome the obstacles created by the heterogeneity of manifestations. Here, we review progress towards the ultimate goal of safely reducing disease activity and preventing damage accrual and death. We discuss the new classification criteria from the European League Against Rheumatism and American College of Rheumatology, novel definitions of remission and low lupus disease activity, and new proposals for the histological classification of lupus nephritis. Recommendations for the treatment of SLE and novel approaches to drug development hold much promise to further enhance SLE outcomes.
系统性红斑狼疮(SLE)的异质性长期以来一直受到临床医生的关注,现在正挑战着从遗传学家到临床研究人员的整个狼疮界。尽管 SLE 患者的预后有了很大改善,但仍存在许多未满足的需求,其中最重要的是开发更安全、更有效的治疗方法。为了开发创新疗法,需要更深入地了解 SLE 发病机制与各种临床表型之间的关系。此外,为了有效地实现这些目标,狼疮界需要改进现有的临床研究工具,并更好地适应这些工具,以克服由表现异质性所带来的障碍。在这里,我们回顾了朝着安全减少疾病活动、预防损伤积累和死亡这一最终目标所取得的进展。我们讨论了欧洲抗风湿病联盟和美国风湿病学会的新分类标准、缓解和低狼疮疾病活动的新定义,以及狼疮肾炎的组织学分类的新建议。SLE 治疗的建议和药物开发的新方法有很大的希望进一步改善 SLE 的结果。
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