Mucke Johanna, Schneider Matthias
Poliklinik für Rheumatologie, Heinrich-Heine-Universität Düsseldorf.
Dtsch Med Wochenschr. 2020 Aug;145(16):1179-1183. doi: 10.1055/a-1037-5326. Epub 2020 Jul 7.
The publication of the new ACR/EULAR classification criteria for systemic lupus erythematosus (SLE) and the revision of the EULAR recommendations for the management of SLE last year include many important novelties that will change the classification and care of lupus patients. This refers to both general basic treatment principles and specific therapy recommendations. For example, SLE can only be classified as such if antinuclear antibodies (ANA) are present, independently of titer height and fluorescence pattern. If ANAs are detected, lupus-specific symptoms and serological abnormalities are assessed and separately scored. A score of 10 and more classifies an SLE patient as such. With regard to the care of SLE patients, every therapeutic decision should follow a treat-to-target approach with the aim of achieving remission. Aim is to ensure long-term survival, reduce damage and improve quality of life. These goals are achieved by early diagnosis, consistent therapy and regular evaluation of disease activity. All patients should receive antimalarials in the absence of contraindications. If the response is inadequate or in case of moderate to severe organ manifestations, steroid pulses over a few days and the early use of immunosuppressive drugs (IM) are recommended. With the inclusion of biologicals, especially belimumab and rituximab, new substance classes made their way into the recommendations.
美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）系统性红斑狼疮（SLE）新分类标准的发布以及去年EULAR关于SLE管理建议的修订包含了许多重要的新内容，这些将改变狼疮患者的分类和治疗。这涉及到一般的基本治疗原则和具体的治疗建议。例如，只有在存在抗核抗体（ANA）时，SLE才能被如此分类，而与滴度高度和荧光模式无关。如果检测到ANA，则评估狼疮特异性症状和血清学异常并分别计分。10分及以上则将患者分类为SLE患者。关于SLE患者的治疗，每一个治疗决策都应遵循达标治疗方法，目标是实现缓解。目的是确保长期生存、减少损害并提高生活质量。这些目标通过早期诊断、持续治疗和定期评估疾病活动来实现。所有患者在无禁忌证的情况下都应接受抗疟药治疗。如果反应不足或出现中度至重度器官表现，建议进行为期数天的类固醇冲击治疗并早期使用免疫抑制药物（IM）。随着生物制剂的纳入，尤其是贝利尤单抗和利妥昔单抗，新的药物类别进入了治疗建议。
