Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Mod Rheumatol Case Rep. 2021 Jul;5(2):259-264. doi: 10.1080/24725625.2021.1881215. Epub 2021 Feb 18.
Glucocorticoids (GCs) use is associated with increased organ damage in systemic lupus erythematosus (SLE), and the treatment goal is to stop their use. Treatment with hydroxychloroquine (HCQ) without daily GCs may benefit patients by minimising the cumulative dose of GCs, but clinical experience with HCQ monotherapy is limited. To accumulate evidence for initial HCQ monotherapy in SLE, we retrospectively analysed three new SLE patients who visited Yokohama City University Hospital in 2015. The patients were all Japanese females with a mean age of 26.0 ± 5.3 years, high anti-dsDNA antibody titres, no major organ damage, and a mean pre-treatment Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score of 9.3 ± 3.1. During the mean observation period of 3.8 ± 0.8 years, none of them received daily GCs or immunosuppressants, but one of the three patients were treated with short-term oral GCs and NSAIDs for a skin rash or arthralgia flairs. SLEDAI-2K was reduced to 3.3 ± 1.2. No other new SLE symptoms emerged, and the Systemic Lupus International Collaborating Clinics Damage Index (SDI) of them were maintained at 0. None of the patients developed HCQ-related retinal toxicity. Current experience with initial HCQ monotherapy suggests that such a therapeutic strategy may be useful in managing disease activity and preserving cumulative GCs in SLE patients without organ involvements.
糖皮质激素（GCs）的使用与系统性红斑狼疮（SLE）中器官损伤的增加有关，治疗目标是停止使用 GCs。使用羟氯喹（HCQ）而不每天使用 GCs 可能通过最小化 GCs 的累积剂量使患者受益，但 HCQ 单药治疗的临床经验有限。为了在 SLE 中积累初始 HCQ 单药治疗的证据，我们回顾性分析了 2015 年在横滨市立大学医院就诊的 3 例新的 SLE 患者。这些患者均为日本女性，平均年龄为 26.0±5.3 岁，抗 dsDNA 抗体滴度高，无主要器官损伤，治疗前系统性红斑狼疮疾病活动指数 2000 分（SLEDAI-2K）平均得分为 9.3±3.1。在平均 3.8±0.8 年的观察期间，他们均未接受每日 GCs 或免疫抑制剂治疗，但其中 1 例因皮疹或关节痛发作而短期口服 GCs 和 NSAIDs 治疗。SLEDAI-2K 降低至 3.3±1.2。没有出现其他新的 SLE 症状，他们的系统性红斑狼疮国际合作临床损伤指数（SDI）均保持在 0。无患者发生与 HCQ 相关的视网膜毒性。初始 HCQ 单药治疗的现有经验表明，对于无器官受累的 SLE 患者，这种治疗策略可能有助于控制疾病活动并保留 GCs 的累积剂量。
